California Practice Wins Rate Increases From Four of Five Dental Plans

A California dental practice secured reimbursement improvements from four of five dental plans after turning its contracting request into a code-level financial case.

In a November 5 case study published by the California Dental Association, Bakersfield practice owner Felicia L. Lai, DDS, described a negotiation that ran from November 2025 through February 2026. Her team did not ask plans for a general fee increase. It selected the procedures that mattered most, documented the practice economics behind them and continued negotiating after initial rejections.

The result is notable because it shows that a smaller independent practice can create leverage without immediately leaving a network or outsourcing the entire process. The specific payers and percentage increases were not disclosed, so the outcome should be read as a practical case study—not a market-wide rate benchmark.

What the practice put in front of payers

The team began with the practice's top 20–30 CDT codes, led by preventive, diagnostic and common restorative services. It also included higher-production procedures such as implant-supported restorations.

For each request, the practice assembled evidence including:

• Actual patient claims and reimbursement
• Contractual write-offs
• Chair time
• Staffing requirements
• Laboratory fees
• Supply and overhead costs
• Treatment details and multiple-appointment requirements

Some examples showed an average write-off of approximately 42%. Several procedures required 75 to 120 minutes of care, giving the plans a clearer view of the resources behind the requested fee.

This is the critical distinction. The practice was not arguing that reimbursement felt inadequate. It was showing where the contract economics were becoming unsustainable.

That same discipline should extend beyond negotiations. Avized's analysis of the connected dental RCM operating system explains why claim, payment, adjustment and payer data become more valuable when they are analyzed as one financial workflow rather than separate administrative tasks.

The negotiation narrowed after the first “no”

When plans responded that the practice was already receiving the highest regional schedule, the team did not end the discussion. It narrowed the original list to three to five priority codes and requested specific target amounts.

Persistence produced improvements on several high-impact services, including crowns, prophylaxis and radiographs. After any increase, the team reviewed the full revised fee schedule to make sure the payer had not reduced other codes to offset the gain.

That review step matters. A headline increase on one procedure can be economically neutral—or negative—if another frequently used code falls. Contracting teams should model the revised schedule against actual utilization before accepting it.

The practice's approach also offers a useful contrast with the administrative changes covered in Avized's recent analysis of Delta Dental's paper-check fee and EFT shift. Payer economics are affected by more than the stated allowed amount. Payment fees, leased-network discounts, remittance friction and contract structure can all change the net value of participation.

The leased-network issue may be the biggest warning

The one unsuccessful negotiation involved a plan that did not permit provider-initiated updates. The practice later learned it had been grandfathered into a commercial direct contract that was no longer offered. Leaving and attempting to rejoin could have pushed the practice into a leased network.

That made termination more complicated than a simple in-network versus out-of-network decision.

Before changing participation, a practice should map:

1. The legal entity holding the contract
2. Whether the relationship is direct or accessed through an umbrella PPO
3. Every downstream plan using the leased fee schedule
4. The patients and revenue attached to each arrangement
5. Re-entry terms if the contract is terminated
6. The financial effect of alternative network access

This is where dental payer data and operational data need to converge. Verification systems help identify the plan presented by the patient, but practices also need to understand which contract and fee schedule actually govern the claim. Avized's dental insurance-verification software guide explains why carrier recognition alone is insufficient for increasingly complex payer workflows.

A repeatable negotiation file

The case study points toward a more durable operating process. Each payer should have a living negotiation file containing:

• Current and prior fee schedules
• Contract and amendment history
• Direct and leased-network relationships
• Utilization by CDT code
• Allowed amount, write-off and net collection by code
• Chair time and variable cost for priority procedures
• Regional benchmark evidence
• Contact history and written responses
• Requested, offered and accepted rates
• Effective dates and post-change payment validation

Maintaining this history changes renegotiation from a periodic scramble into a recurring management process. It also makes the next request stronger because the practice can show how reimbursement, costs and utilization have changed since the last review.

What to watch next

Actual increase size. CDA did not publish the negotiated percentages or dollar amounts. Practices should not assume the same outcome without evaluating their own market position and payer mix.

Time versus return. The process took several months and required the owner plus two team members. The value of the resulting increases should be compared with the labor required to win them.

Offsets and implementation. A signed schedule does not guarantee correct payment. Teams should validate early claims against the new rates and watch for offsetting changes elsewhere in the schedule.

Network structure. Direct contracts, umbrella PPOs and leased networks can produce different rates for patients who appear to carry the same payer brand.

Negotiation cadence. The practice reported that reconsideration windows commonly ranged from 12 to 24 months depending on the contract. A centralized renewal calendar is therefore as important as the analytical model.

The broader lesson is straightforward: payer negotiation is not a letter-writing exercise. It is an evidence workflow. The practices most likely to create leverage are those that know which codes matter, can prove the financial gap and preserve a history of every contract, request and outcome.

Primary source

• California Dental Association — California dentist credits patience and persistence for successful renegotiation of plan reimbursement rates, November 5, 2026

All practice results and negotiation details are attributed to CDA's interview with Dr. Lai. Avized's workflow and market implications are independent editorial analysis.