Why a January Fee Increase Doesn’t Fix Your Revenue (and Often Makes It Worse)

Fees are reviewed.

• A consultant references a survey.

• A percentage increase is applied.

• And nothing meaningful changes.

In fact, for many practices, January fee increases quietly hurt the very patients who pay the practice the most, while insurance carriers remain completely unaffected.

This isn’t an accident. It’s how the system is designed.

The Fee Survey Illusion

Fee surveys are often presented as neutral benchmarks—a way for dentists to confirm they are “priced appropriately” for their market.

But fee inflation is not an unintended consequence of these surveys. It is structurally useful to insurance carriers.

Insurance companies benefit when dental office fees appear high, disconnected, and inconsistent. That perception makes the dental benefit product itself feel necessary.

Here’s why.

Data Contamination Starts at the Source

Even if fee surveys were well intentioned, many are fundamentally compromised by how the data is submitted.

Some consultants actively instruct practices to submit their contracted PPO rates as their UCRs. Others don’t instruct it—but offices do it anyway, often by mistake.

As a result, surveys routinely collect PPO-suppressed fees, discounted schedules, and network-influenced numbers labeled as “UCR.”

Once that happens, the survey stops reflecting market pricing and starts reflecting insurance behavior.

Precision Built on Isolation

Dentists are effectively prohibited from sharing their office fees with one another. As a result, independent practices are isolated when it comes to pricing, with no practical way to validate fees against peers.

That isolation allows office fees to drift upward without meaningful market correction.

The effect is subtle but powerful. Inflated sticker prices are normalized, discounts feel necessary, and insurance becomes the mechanism that “fixes” the very problem those inflated fees create.

Office fees, untethered from real market validation, end up creating the market for dental insurance—not challenging it.

ZIP Codes Don’t Fix Bad Inputs

This is where ZIP-code–based surveys add a false sense of sophistication.

When contaminated data is grouped by ZIP code, averaged, and presented as “market-appropriate fees,” the output looks precise—but the inputs are already compromised.

ZIP codes are useful for actuarial modeling and premium pricing. They are not a reliable driver of provider reimbursement leverage. A practice in a high-income ZIP code that is easily replaceable and overcontracted has no pricing power, regardless of what a survey suggests.

The Illusion, Made Complete

Fee surveys don’t empower dentists to set better prices.

They normalize a system where office fees rise, reimbursement does not, patients feel the pressure, and insurance expands its role as the solution.

The illusion isn’t that surveys exist. It’s that they’re treated as market truth—when they’re often just a reflection of the insurance ecosystem looking back at itself.

Insurance Does Not Respond to Fee Increases the Way Dentists Expect

It’s true that insurance carriers can and do renegotiate fees.

In certain negotiations, carriers will reference an office’s submitted fees and may require a 30–40% write-off to justify an updated schedule. In those cases, an office fee schedule does matter.

The mistake is believing that raising fees alone creates leverage. It doesn’t.

Why Fee Increases Rarely Translate Into Meaningful PPO Increases

Insurance negotiations are not based solely on UCRs. They are based on a practice’s leverage within the carrier’s ecosystem.

For practices that are overcontracted, participating broadly across competing networks, or accessible through leased arrangements, the carrier already has access to the practice.

When access is guaranteed, fee pressure disappears.

So even if an office raises its fees by 10%, the carrier may respond with a 2–3% increase, a minor adjustment to select codes, or no meaningful movement at all.

At that point, the fee increase has accomplished very little—except increasing write-offs and patient friction.

The Overcontracting Problem

If a carrier knows a practice is in-network elsewhere, that patients have multiple ways to access the office, and that termination risk is low, negotiations become symbolic.

Contract stacking neutralizes leverage. In that environment, UCR positioning is irrelevant.

The Wrong Math Dentists Are Taught to Accept

Why raise office fees by 10% to justify a 3% contracted increase that only applies to a subset of codes—while increasing write-offs across the board?

That’s not strategy. That’s optics.

The Hidden Penalty on Cash and Out-of-Network Patients

Cash-pay and out-of-network patients are often a practice’s most loyal, least administratively burdensome, and highest net contributors.

A blanket January fee increase disproportionately affects them.

In-house membership plans are often introduced to soften the impact. While operationally helpful, these plans still rely on discounts off inflated office fees, reinforcing the same pricing illusion.

The carrier may be removed from the equation, but the practice is still discounting against itself.

January Is the Worst Time to Raise Fees

January feels logical on paper. Operationally, it’s chaotic.

Open enrollment decisions have just taken effect. New plans, new networks, and new exclusions arrive without warning. Practices have no historical data on how these plans will behave.

Raising fees at the same time adds friction to an already unstable environment—before the practice even understands its new payer mix.

Micro-FAQ: Common Questions About Dental Fee Increases

Does raising office fees increase insurance reimbursement?
Not by itself. Insurance reimbursement is governed by provider contracts and network leverage, not by published office fees. Without structural leverage, fee increases mainly inflate contractual write-offs.

Are dental fee surveys accurate reflections of the market?
Often not. Many surveys rely on insurance-influenced data, including contracted rates submitted as UCRs. They frequently reflect payer behavior rather than real cash collections.

Do ZIP codes justify higher dental fees?
ZIP codes are useful for actuarial and premium pricing purposes, but they rarely create provider leverage. Reimbursement is driven by network access and contract positioning, not geography alone.

The Bottom Line

If your January fee increase didn’t improve cash flow, increased write-offs, created patient friction, and left insurance reimbursement untouched, the problem wasn’t the percentage.

It was the premise.

Until practices stop letting insurance company-derived data dictate pricing decisions, fee increases will continue to punish the wrong people—and protect the wrong entities.

That said, office fees do still matter when they are adjusted strategically.

Solutions-101 maintains the largest real-world reimbursement databases in the dental industry. Using observed network reimbursement behavior—not surveys or ZIP-code estimates—we help practices apply fee titration: calibrated fee adjustments designed to maximize dental insurance benefits without pricing patients out of care.

The goal isn’t higher sticker prices. It’s aligning fees with how plans actually pay, so practices capture available benefits while maintaining patient trust.