0 · Pre-call prep
5 min before dial
Walk in already knowing the shape of the practice.
- Confirm specialty, provider count, and locations from their site before you dial.
- Note the two commercial carriers most likely dominant in their state.
- Have the benchmark one-pager and a blank fee-schedule request open.
Listen for
- Recent expansion — new providers or locations means contracts are stale by definition.
- Ownership: independent, PE-backed, or hospital-affiliated changes who signs.
If they say
- Hospital-owned or fully Medicare/MedicaidDisqualify politely on the call — no commercial contracts means no engagement.
Transition: Dial on the minute. First words are the reason for the call, not a greeting script.
Frame the call as a rate review, not a pitch, and earn the next twenty minutes.
- "Thanks for making time. The reason for the call is simple: most independent practices are being paid off commercial contracts they signed years ago that quietly auto-renew at the same rates. I want to spend twenty minutes seeing whether that's happening to you."
- "I'm going to ask about your payer mix and your billing volume, and if there's nothing there, I'll tell you that on this call."
- "Fair?"
Listen for
- "We've looked at that before" — good, ask what they found and when.
- Rushed tone — collapse to two questions and book the real call.
If they say
- "I only have ten minutes.""Then let's use them on two numbers: commercial volume and when the contracts were last touched. If it's worth more time, we book it before we hang up."
- Gatekeeper answers"I'm calling about the practice's commercial payer contracts — the rate side, not billing. Who owns those?"
Transition: "Let me ask you a few things about how you're set up today."
Get billing volume, payer count, and contract age on the table — in their words.
- "Roughly what are you grossing a year in commercial insurance billing — not Medicare, not Medicaid, just commercial?"
- "Which commercial carriers make up most of that? Aetna, United, Cigna, Blue Cross, Humana?"
- "When was the last time any of those contracts was actually renegotiated — not renewed, renegotiated?"
- "Do you have the fee schedules on file, or do you only see what lands in the remits?"
Listen for
- Any hesitation on the volume number — they may not track commercial separately. That itself is the opening.
- "It just renews" — the auto-renewal trap, quote it back later.
- Three or more carriers means a multi-contract engagement.
If they say
- "I don't know our commercial volume.""That's common and it's fixable — who pulls collections by payer for you? Get me one month and I can extrapolate the year."
- Contracts renegotiated in the last 12 months"Then the question is whether the increase you got matched the market. What percent of Medicare did you land at?"
Transition: "Let me show you what we usually find when nobody's touched those in a few years."
Make rate asymmetry concrete, personal, and clearly not their fault.
- "Here's what we consistently find: commercial pay ranges from roughly 117% to 243% of Medicare for the same procedure depending on the contract. The national average is around 148%. The payer knows exactly where you sit in that spread. Most practices don't."
- "Every year a contract goes untouched, it loses ground to inflation. Since 2001, premiums are up 282% and physician payment is down 15.5% in real terms."
- "That gap isn't an accident — it's a negotiated outcome, and only one side has been negotiating."
Listen for
- Frustration language — "we've asked before," "they never respond." That's the hook for the offer.
- Silence after the 243% figure usually means they're doing the math on themselves. Let it sit.
If they say
- "We're probably fine.""Maybe. Fine relative to what, though? Nobody has scored your schedule against the region. That's a one-week answer, not a guess."
Transition: "Let's put your actual numbers against that."
Model their number out loud and let the arithmetic carry the call.
- "Let's use your numbers. If you're at $X million commercial and we move you even a handful of points toward the market ceiling, that's $Y a year — on volume you're already producing. No new patients, no new staff, no new equipment."
- "That's why we do the analysis first. We pull your fee schedules, score them code by code against regional benchmarks, and show you where each carrier is underpaying before you commit to anything."
- "If the schedule comes back at or above market, I'll tell you and there's no engagement."
Listen for
- They restate the number back to you — that's a buying signal, move to terms.
- They ask "how long does that take" — timeline questions are commitment questions.
If they say
- "How confident are you in that number?""It's a modeled range, not a promise, and it comes from your own volume. The analysis replaces the range with a code-level figure."
Transition: "Let me tell you exactly how the engagement works so there are no surprises."
5 · Offer & terms
18:00 – 24:00
State the engagement plainly and anchor cost against upside, not against zero.
- "The engagement is a $2,000 retainer per commercial carrier contract we take to the table. That covers the analysis, the benchmark package and the negotiation itself."
- "Beyond that we're paid on performance — a share of the incremental revenue we actually win you. If rates don't move, that side of it doesn't pay."
- "Everything is signed electronically. Nothing gets sent to a payer without your sign-off."
Listen for
- "Per contract?" — clarify immediately, then re-anchor on annual upside.
- They start naming which carriers to start with. That's the close beginning on its own.
If they say
- "Can we start with one carrier?""Yes, and I'd recommend it. Pick the worst payer with the most volume and we prove it there first."
Transition: "So here's what I need from you to start."
One decision, one date, two deliverables.
- "Two things get this moving: the agreement, and your current fee schedules for the carriers we picked. Can you get those to me this week?"
- "I'll block the analysis slot for you now and we'll review findings together on the follow-up. Does the same time next week work?"
- "I'll send the agreement in the next few minutes — it's electronic, takes about two minutes."
Listen for
- Any date they name — write it down and repeat it back.
- "Let me think about it" without a date means the upside wasn't concrete enough. Return to stage 4.
If they say
- "Send it over and I'll look.""I'll send it now. Let's hold ten minutes on Thursday so it doesn't sit — if you've signed by then we'll use the time on carrier selection."
Transition: Confirm the follow-up on the calendar before the call ends. Never end on "I'll check back."
7 · Post-call follow-up
Within 30 minutes
Convert stated intent into signed documents.
- Send the agreement, the benchmark one-pager, and a one-line recap of the number you modeled together.
- "Recapping: roughly $Y a year on your existing commercial volume, starting with [carrier]. Agreement attached, fee schedules when you can."
- Day 3 nudge, day 7 call, then quarterly touch if it stalls.
Listen for
- No reply in 72 hours usually means an unspoken partner or cash-flow objection — call, don't email again.
If they say
- Signed but no fee schedulesOffer to request them from the biller directly with a short authorization — remove the work from their desk.
Transition: Mark the appointment outcome in the portal the same day.