When Was the Last Time You Raised Your Fees?

Stop for a moment and think about this question: When was the last time you raised your dental fees? Many dentists can't answer that question without thinking hard—sometimes searching through records to remember. And that silence itself is revealing. The reality is shocking: some PPO-dependent practices haven't raised fees in 8, 10, or even 13 years. Meanwhile, inflation has made everything else cost more.

The Inflation Reality

Everything costs more. You don't need an economist to tell you this—you experience it every time you buy groceries, fill your car with gas, or pay a restaurant bill. Everything from a loaf of bread to a gallon of milk to a pound of hamburger has increased dramatically. We're not talking about small, typical cost-of-living increases. We're talking about 20-30% jumps in many cases.

Restaurant owners have raised prices. Hotel managers have raised rates. Store owners have increased their costs. Every business—except dentistry—has passed along increased costs to consumers.

The reason is both simple and profound: approximately 97% of dentists are contracted with PPO plans. And here's the critical reality: when you're a PPO provider, you don't set your fees anymore. The insurance company does.

The Problem with PPO Fee Schedules

Who Actually Controls Your Fees?

Many dentists think they control their fees. They publish a fee schedule. But the reality is different. When you're in-network with a PPO plan, your actual collected fee is whatever the contract specifies—not what you think you're charging. The insurance company has already determined what you'll get paid for each procedure.

Even more troubling: many practices don't actively review or understand what they're actually being paid. One dentist discovered that Delta of New Jersey hadn't increased fees for participating providers since 2009. Thirteen years. Zero increase.

The Cost Inflation While Fees Freeze

While PPO fee schedules stagnate, your costs have skyrocketed:

• Team salary increases: If you want to retain hygienists and dental assistants in a competitive market, you have to pay more. Much more. One practice looking to hire found two candidates both requested twice the hourly rate of their departing assistant.
• Supplies and materials: Composite resins, cements, impression materials—all cost significantly more than they did 5-10 years ago.
• Technology investments: A new CBCT, digital scanner, or advanced software requires substantial investment.
• Staff benefits: Health insurance premiums, retirement contributions, and other benefits have all increased.
• Facility costs: Rent, utilities, and property maintenance don't stay flat.
• Continuing education: Investing in your team's knowledge and your own professional development costs more each year.

Meanwhile, if you're PPO-dependent, your fees haven't changed. Or they've changed minimally. You're being squeezed from both sides: rising costs and frozen revenue.

The Fairness Dilemma

Here's why many dentists accept this unfair situation: they're inherently fair people. Most dentists have a deep sense of justice. They look at their fee schedule and think: "My fee-for-service patients are paying full price. My PPO patients are paying the contracted price. If I raise fees, I'm only raising them on my fee-for-service patients. Isn't that asking them to subsidize my PPO patients?"

That's the fairness dilemma. And it's why many dentists haven't raised fees in years.

The Real Problem with This Logic

This thinking is understandable but backwards. When you maintain below-market fees for your fee-for-service patients to "offset" unfairly low PPO fees, you're actually subsidizing the insurance companies, not balancing your books.

Here's a concrete example: One practice had only 6 fee-for-service patients out of approximately 300 total patients. That means 99.8% of patients were PPO. The owner raised fees on those 6 patients? Absolutely not—that would feel unfair. But by not raising fees on anyone, she's giving away approximately $400,000 per year due to the PPO discount on the 294 PPO patients.

The math doesn't work. One practice owner discovered this reality and made a decisive move: she raised her fees for her small fee-for-service patient base. Did she lose those patients? No. She lost less than 5% of her patient base, became significantly more profitable, and said afterward that it was the best decision she'd made in her career.

Understanding Your Current Fee Schedule

How Many Patients Are Actually Fee-For-Service?

This is the first question to answer. Pull your numbers. What percentage of your active patients are PPO versus fee-for-service? Is it 70% PPO / 30% fee-for-service? Or is it 90%+ PPO?

Most PPO-dependent practices discover their percentage is higher than they thought. Very high. Often 80-95% PPO.

How Much Are You Actually Collecting Per Procedure?

For PPO procedures, the contracted fee is reality. For fee-for-service, if you've had the same fee schedule for years, you're losing money to inflation monthly.

When to Raise Fees: Before or After PPO Transition?

Ideal Timing: Index Before You Leave Network

The best time to raise fees is before you transition away from PPO plans. Here's why:

• When you have a large percentage of PPO patients (80-95%), raising fees on that group is difficult psychologically
• Once you leave PPO and have 100% fee-for-service patients, raising fees across the board feels more natural and fair
• You're setting the baseline for your new independent practice

However, if you have a small percentage of fee-for-service patients (less than 10%), raising fees on just that group should not be seen as unfair. It's simply market correction.

How Much Should You Raise Fees?

This is where professional guidance becomes essential. You cannot determine this yourself—the FTC has rules against dentist associations setting fee guidelines (they consider it price-fixing). However, your CPA or accountant can provide guidance.

Getting Professional Fee Consultation

Work with Your CPA

If you're not already working with an accountant who specializes in dental practices, this is an excellent time to engage one. They have:

• Benchmark data from hundreds of practices
• Understanding of your specific costs and variables
• Ability to analyze your fee schedule against regional and national standards
• Tax implications expertise

Find a Dental-Focused CPA

Look specifically for CPAs who are members of the Academy of Dental CPAs (ADCPA). These are 24 independent accounting firms across the country that work exclusively with dental practices. Collectively, they serve over 10,000 practices and have enormous comparative data.

Visit ADCPA.org to find a firm in your area. While they cannot tell you specific fees (that would be price-fixing), they can provide guidance on how other practices index fees based on inflation, technology investments, cost increases, and regional markets.

A Historical Perspective: When Fee Setting Was Different

It's worth understanding the history of how we got here. Forty years ago, dentists actively managed their own fees. One established dentist took advice about indexing fees for inflation in 1982—when interest rates were 21-22% and inflation was rampant. This doctor considered the advice, thought about wage increases he'd given his team, technology investments, and continuing education costs, and decided to double his fees.

His coach was horrified. "I didn't say double your fees!" But the doctor was confident in the value his practice delivered. He went back and doubled his fees.

What happened? He lost less than 5% of his patients. And more importantly: he said afterward that the next four years (ages 62-66) were the most enjoyable of his entire career. Higher profitability meant less financial stress. Less financial stress meant he could focus on the quality of care he provided and genuinely enjoy his work.

That doctor made a critical discovery: patients care less about absolute fees than dentists think they will. What matters is value delivered relative to cost. When a patient perceives real value—cutting-edge technology, excellent clinical outcomes, great patient experience, minimal insurance hassles—fee resistance is minimal.

The Team Cost Reality

There's another factor to consider: your team's salaries must increase. If you want to keep your hygienists, dental assistants, and office staff—especially in a competitive job market—you have to pay competitively. When talented team members can get higher pay elsewhere, they leave.

You may have to increase team member compensation by 15-20% just to stay competitive. That's not optional—that's market reality. And if your fees don't increase, where does that additional cost come from? Your profits. Your ability to invest in practice improvement. Your personal income.

Moving to Action: Three Steps

Step 1: Understand Your Current Fee Schedule

• List your top 20 procedures by frequency
• Note your current fee for each
• Calculate what you're actually collecting (contracted PPO rates)
• Calculate what a fee-for-service patient pays

Step 2: Engage a Dental CPA

• Find a member of ADCPA in your area
• Discuss your cost increases over the past 5-10 years
• Get their guidance on reasonable fee adjustments
• Understand the tax implications

Step 3: Create Your New Fee Schedule

• Don't increase all fees equally—market variation is real
• Increase fees on high-value treatments more than routine treatments
• Phase increases if you're concerned about patient response
• Communicate clearly with patients when fees increase

The Fear of Patient Loss

The biggest fear dentists express about raising fees is: "I'll lose all my patients." This fear is typically based on false evidence appearing real (FEAR). In reality:

• Reasonable fee increases (10-20%) rarely cause significant patient loss
• Most patient loss comes from poor quality or bad experience—not from reasonable fee increases
• Patients who perceive strong value don't leave because of modest fee increases
• A small percentage of patients may leave—and that's actually fine. Patients who are hyper-sensitive to price are often more difficult, lower-production patients anyway

The historical example bears this out: a doctor who doubled fees lost 5% of his patient base. That's exceptional, but it demonstrates the principle: patients stay when they feel genuine value.

Special Consideration: Still Using Insurance

If you're planning to remain in-network with some insurance plans (a hybrid approach), fee setting becomes more complex. Your CPA can help navigate this. However, realize that contracted plans will still limit your actual revenue, so fee increases must be strategic.

Reviewed by

Naren Arulrajah

CEO & Founder, Ekwa Marketing

Naren Arulrajah is the CEO and Founder of Ekwa Marketing, a 300-person dental marketing agency that has helped hundreds of practices grow through SEO, reputation management, and digital strategy. A published author of three books on dental marketing, contributor to Dentistry IQ, co-host of the Thriving Dentist Show and the Less Insurance Dependence Podcast, and a member of the Academy of Dental Management Consultants. He has spent 19 years focused exclusively on helping dental practices succeed online.