Most practices sign PPO contracts the same way. The payor sends over an agreement, someone reviews the fee schedule page, and if the rates look acceptable, it gets signed. Done.
The problem is that the fee schedule page doesn't determine your actual reimbursement. The network participation language does. And that language — buried in the terms and conditions — is where DSOs lose millions of dollars annually without ever realizing it.
Three questions, asked before signing, would prevent most of it.
This is the foundational question. Almost every major dental PPO plan operates with some form of network leasing — the practice of allowing other insurance companies or third-party networks to access your participation agreement without requiring you to sign a separate contract with them.
When a plan leases your participation, those downstream networks can apply their own fee schedules to claims from their subscribers — even though you never contracted with them. If their fee schedule is lower than the plan you did contract with, you get paid at the lower rate.
Ask the payor representative directly: "Which networks have access to my participation under this agreement?" Then ask for the list in writing.
Once you know which networks have access to your participation, the next question is: which fee schedule wins when more than one could apply?
Some plans have hierarchy language that specifies their contracted rate takes precedence over any downstream network rate. Others have language — explicit or implied — that allows the lowest available rate to apply. The difference is often thousands of dollars per location per month.
Ask specifically: "If a claim from a subscriber in a leased network routes through your plan, which fee schedule applies — your contracted rate with me, or the leased network's contracted rate?"
A most-favored-nation (MFN) clause requires you to give the contracting payor your lowest contracted rate for any given procedure — meaning if you later negotiate a lower fee schedule with another payor, you're contractually obligated to extend that same rate to the MFN payor.
This clause is increasingly common in dental PPO agreements and is one of the most significant constraints on future contracting flexibility. It effectively prevents you from selectively reducing rates for lower-volume plans without triggering a rate reduction across your higher-volume relationships.
Ask directly: "Does this agreement contain a most-favored-nation provision? If so, how is 'most favored rate' defined, and what triggers the notification obligation?"
The honest answer is that the payor representative presenting the contract isn't going to volunteer this information. Their job is to get the contract signed. These questions create friction. Many practice managers and even experienced billing directors don't know to ask them.
The other reason: the answers require legal and network intelligence to evaluate. Knowing that a plan leases your participation to "affiliated networks" doesn't help unless you know what those networks are and what fee schedules they carry.
Knowing the routing before you sign is the entire value proposition of network intelligence. The questions above open the door — the data behind the answers determines whether you should walk through it.
PayorMap maps every leased network relationship across all major dental payors, including the fee schedule hierarchy for each routing path. Before you sign with any major plan, you can run the payor through the Routing Query to see which networks are likely to have access to your participation, what the probable repricing chain looks like, and what the financial implications are.
It doesn't replace a contract attorney. But it means you walk into the conversation knowing the routing — and knowing which questions actually matter for this specific payor.
Enter any payor and see the full network routing map, fee schedule hierarchy, and repricing probability in seconds. Free 7-day trial.
Start Free Trial →