PPO fee schedules don't rise on their own. Left alone, they quietly fall behind inflation year after year while your costs climb — a slow squeeze on margin that never shows up as a single bad month. Renegotiation is how you claw it back, and timing matters.
Why fees drift.
You signed a fee schedule once, often years ago, and the payer has no incentive to revisit it. Meanwhile staff wages, lab bills, and supply costs have all risen. If you haven't reviewed contracted rates in two or three years, you're almost certainly being paid on stale numbers.
Signs it's time.
Reimbursement well below your regional average, a plan that drives high volume at low margin, a milestone like adding a provider or location, or simply years since the last review. Any one of these is a reason to open the conversation.
If it's been two to three years since you reviewed a PPO fee schedule, you're likely being reimbursed below current market — and below your own rising costs.
What actually moves a payer.
Data, not frustration. Payers respond to your patient volume for their members, your standing in the local market, and clear benchmarking against comparable rates. Come with numbers and a specific ask, prioritizing the plans with the most volume and the widest gap first. This is part of what a credentialing partner should handle — see what to look for in one and our credentialing service. Want help spotting your underpaying plans? Book a call.