Every PPO consultant promises fee increases. The difference is how they get them, and what they leave behind.
Hiring someone to negotiate your insurance contracts is a decision that shapes your revenue for years. Before you sign, ask these eight questions.
1. How are you paid?
Flat-fee models have to protect their margin, which pushes them toward the fastest and least complex wins. A percentage-based model gets paid when you do. The structure tells you which path a consultant is motivated to take.
2. Will you show me more than one strategy?
A single recommendation is a template. Ask for multiple options that spell out projected gain, risk level, network retention impact, operational effect, and timeline. Then you choose based on your goals.
3. Do you negotiate with difficult carriers?
Some consultants quietly skip carriers that push back. Ask directly which carriers they won’t pursue, and why.
4. How do you evaluate rental and leased networks?
A direct offer can look strong in isolation. A 20% increase on a $600 crown brings it to $720. Run the same procedure through an alternative network and the range may be $840 to $1,000. If a consultant only negotiates one contract at a time, you’ll never see that comparison.
5. Who handles credentialing?
Credentialing a dental office can take more than 30 hours. A missed form can delay a new fee schedule by months. Find out whether credentialing is included, and who tracks it until you’re officially in network.
6. What happens if a carrier delays?
Carrier delays are common. Ask whether a longer timeline means additional fees. It shouldn’t.
7. How will you train my team afterward?
A negotiated increase only matters if it’s collected. Your team needs to know how to confirm EOBs are paid at the new rates, catch underpayments, and spot rental routing problems early.
8. What results can you show me?
Ask for specifics. Our clients’ results include reimbursement increases of nearly 20%, and our process averages at least a 24% increase in PPO reimbursements, with an average ROI of nearly 10 to 1.
Red Flags to Watch For
- A guaranteed number before they’ve seen your data
- No analysis of your payor mix or patient base
- Recommending you drop several carriers at once without a phased plan
- No plan for staff training after the contracts are signed
See how our process answers all eight questions. Start with a complimentary PPO Revenue Assessment.
