The honest version of this guide starts with a number: Arcane Marketing’s average PPC client earns $4.14 for every $1 of ad spend after 4 or more months under management.
That number is real. It is also not automatic. It takes the right structure, the right targeting, the right landing pages, and consistent optimization. Any agency can run Google Ads. Very few do it at a level that actually produces that return.
This guide is for business owners who are about to hand over their ad budget to someone. It covers the questions you should ask, the red flags that will save you thousands, and the specific things a good PPC company does differently from a mediocre one.
What PPC Actually Is (and What It Is Not)
PPC stands for pay-per-click. You create ads, and you only pay when someone clicks them. The most common platform is Google Ads, which lets you bid on specific search queries so your practice or business appears at the top of results before the organic listings.
That top position is rented, not earned. The second you stop paying, the visibility stops. That is the key difference between PPC and SEO: PPC is the faucet, SEO is the well. Both have their place. A practice that runs both simultaneously consistently outperforms one that runs only one or the other.
There are 3 main formats:
- Search ads appear when someone types a specific query into Google or Bing. These are the most intent-driven ads in existence because you are only showing up for people who are actively looking for what you offer. If a prospective patient searches “dental implants cost near me” and you have a campaign targeting that phrase, your ad appears at the top. That patient is not browsing. They are deciding.
- Display ads are image-based banners that run across websites in Google’s Display Network. Lower intent than search, but useful for brand awareness and remarketing.
- Remarketing ads follow people who have already visited your website. Someone looked at your services page but didn’t book? Remarketing shows them your ad across other websites and platforms for days afterward. These tend to convert at a higher rate because the audience is already familiar with your brand.
Most healthcare practices should focus on search ads first, then layer in remarketing once campaigns are producing baseline data.
PPC vs. SEO: How They Actually Fit Together
This is worth addressing directly because a lot of business owners treat it as an either/or decision.
PPC produces immediate results. A well-built campaign can be live and generating clicks within a week. It is the fastest path to new patient volume when you need it.
SEO builds compounding authority over time. Arcane Marketing SEO clients average 320%+ ROI after 12 months. That number takes time to develop, but it does not stop growing the way PPC does when you cut the budget.
The smartest use of both: run PPC to fill the schedule while SEO builds the long-term foundation. Think of the Core 4 framework, which is the integrated approach to digital marketing that includes SEO, GEO (AI search visibility), social media, and video. PPC is not one of the 4 pillars, but it runs alongside them as a direct-response accelerator. A practice that is investing in SEO, content, and video while also running targeted Google Ads is compounding its results across every channel simultaneously.
Running PPC without building anything organic is like renting an apartment forever. You always get a place to sleep, but you never build equity.
The 8 Questions to Ask Every PPC Agency Before You Sign
These are not softballs. They are the questions that separate capable management from polished pitch decks.
1. What is your average cost-per-new-patient (or cost-per-lead) for clients in my industry?
Any agency managing real campaigns at real volume can answer this. If the answer is vague (“it depends on a lot of factors”), that is true to a point, but a competent agency has benchmarks. Push for specifics. For healthcare practices in most markets, a well-managed search campaign should produce leads in the $40 to $120 range depending on the service. Dental implant leads run higher. New patient leads for family dentistry run lower.
If they can’t give you a number, they either don’t track it or they don’t have the data because results aren’t repeatable.
2. Do you build service-specific landing pages, or do you send traffic to my website?
This is a make-or-break question. Sending ad traffic to your homepage is one of the most common and most expensive mistakes in PPC management.
Here is why it matters: if someone searches “emergency dentist open now” and clicks your ad, they land on a page that talks about your whole practice, your team, your services, and has 6 different ways to navigate away. The urgency is gone. The relevance evaporated. The conversion rate drops from 3% to under 1%.
A service-specific landing page for that query says: “We have same-day emergency appointments. Here is the number. Here is the form.” One message, one call to action. That is the difference between a campaign that breaks even and one that produces a $4 return per dollar.
Ask to see an example of a landing page they have built for a current client.
3. How do you track phone calls back to specific keywords?
If an agency cannot tell you which keyword produced which call, they are managing your campaign by feel, not data. Call tracking should be built into every healthcare PPC campaign from day 1. Tools like CallRail assign unique phone numbers to specific ads and keywords, so you know exactly which search terms are producing real calls and which ones are eating budget without results.
Without call tracking, you might as well be running a billboard.
4. Who owns the Google Ads account?
This matters more than most business owners realize. Some agencies build campaigns in their own accounts and maintain ownership. When you leave, you leave empty-handed: no data, no history, no performance benchmarks. You start over from scratch with the next agency.
Require that the account is created under your business’s Google account and that you have admin access at all times. Any agency that pushes back on this is a hard pass.
5. What does the first 90 days look like?
A competent agency can walk you through this clearly. Month 1 is data collection: the campaign goes live, keywords are monitored, click data starts coming in. Month 2 is refinement: low-performing keywords get paused, bids get adjusted, landing page variables get tested. Month 3 is where repeatable results begin to emerge.
Anyone promising “amazing results in the first month” either doesn’t understand how Google Ads works or is telling you what you want to hear.
6. What is your negative keyword strategy?
This is a question that separates the serious from the amateur. Without a strong negative keyword list, your budget leaks constantly to irrelevant clicks.
Here is a real example: a dental practice running ads for “dental implants” will also show up for “dental implant kit DIY,” “dental assistant jobs,” “dental implant complaints,” and “dental school cheap.” Every one of those clicks costs money. None of them will call to book.
A good negative keyword list for a dental PPC campaign might include terms like: “free,” “jobs,” “school,” “DIY,” “cheap,” “insurance quotes,” “reviews reddit,” and dozens more. A well-managed campaign actively expands this list every week based on search term reports.
Ask how often they review search term data and how they maintain negative keywords.
7. How do you structure campaigns, and why?
The internal structure of a Google Ads account significantly affects performance. A well-structured account separates campaigns by service type (emergency dental, cosmetic procedures, general dental), uses tightly themed ad groups within each campaign, and matches the ad copy to the specific keyword group so that the message the searcher sees is highly relevant to what they typed.
A poorly structured account throws multiple services into one campaign, uses broad match keywords without controls, and runs the same generic ad copy for everything. The result is a low Quality Score, higher cost-per-click, and weak conversion rates.
Ask them to walk you through how a current client’s account is structured. If they can’t or won’t, that is an answer.
8. What is your management fee structure, and what does it include?
Pricing models vary: flat monthly fee, percentage of ad spend, or a hybrid. None of these is inherently better, but you need to know exactly what you are paying for.
Common flat fee range: $500 to $2,000 per month for small to mid-size campaigns. Percentage of ad spend models typically run 10 to 20%. Watch for agencies that charge percentage of ad spend, as they have a financial incentive to increase your budget regardless of whether it is producing returns.
What the fee should include: campaign setup, keyword research, ad copywriting, landing page management or recommendations, bid adjustments, negative keyword maintenance, call tracking setup, and a monthly performance report that explains what actually happened.
What it should not include: charging you extra every time they write a new ad or update a landing page. Optimization is ongoing. It should be in the base agreement.
The Red Flags That Should Make You Walk Away
Beyond the questions, watch for these patterns:
- They promise a specific position on Google. No one can guarantee Google ad positions. Quality Score, competition, and budget all affect placement in real time. “We’ll get you to position 1” is a sales line, not a strategy.
- They cannot explain their strategy in plain language. If you ask how they are going to structure your campaign and the answer is word salad, that is a sign they are either hiding something or they do not actually know. A competent PPC manager can explain campaign structure to a 10-year-old.
- They send you a report full of impressions and clicks but no calls or leads. Impressions and clicks are inputs. Calls, form fills, and booked appointments are outputs. A report that leads with vanity metrics and buries (or omits) conversion data is not designed to inform you. It is designed to make you feel good about keeping the relationship.
- They cannot name a specific change they made last month and why. Optimization is not a vague background activity. A good agency should be able to tell you: “We paused 3 keywords that were getting clicks but no conversions, added 14 new negatives based on the search term report, and split the implants campaign into 2 ad groups so we could write more specific copy. CTR went from 4.2% to 6.1%.” If the answer is “we’re constantly optimizing,” ask for specifics.
- Your account has not changed in 30 days. Pull your Google Ads change history. If nothing has been touched, nothing has been managed.
Frequently Asked Questions About PPC Management Companies
How much should I budget for PPC management?
Plan for 2 separate costs: the management fee and the ad spend. For healthcare practices in most markets, a starting ad spend of $1,500 to $2,500 per month is the minimum to gather enough data for optimization. Management fees typically range from $500 to $1,500 per month depending on campaign scope. Larger practices or competitive markets (major metros, high-value services like dental implants or cosmetic surgery) often spend $3,000 to $8,000 per month in total ad spend to compete effectively.
How long before I see results from PPC?
Clicks can start within days of a campaign going live. Consistent, repeatable results with a reliable cost-per-lead typically emerge after 60 to 90 days. Month 1 is data collection. Month 2 is refinement. Month 3 is where patterns become clear enough to optimize against.
What is a good return on PPC for a healthcare practice?
For a well-managed campaign, a new patient lead cost in the $50 to $120 range is reasonable for most general healthcare searches. High-value procedure searches (dental implants, cosmetic surgery, elective procedures) cost more per lead but generate significantly higher patient lifetime value. Arcane Marketing’s average PPC client returns $4.14 per $1 of ad spend after 4 or more months under management.
Should I run PPC or SEO first?
Ideally both, because they do different things. PPC fills your schedule now. SEO builds authority that produces returns for years. If budget requires choosing one to start, PPC produces results faster. But the practices with the strongest patient acquisition build both simultaneously.
What platforms should a healthcare practice use for PPC?
Google Ads is the primary platform for most healthcare practices, as it captures the highest volume of high-intent health-related searches. Microsoft Ads (Bing) supplements Google at lower cost-per-click in many markets and is worth adding once Google campaigns are performing well. Meta (Facebook and Instagram) works well for elective and cosmetic procedures where visual content and social proof drive decisions. TikTok Ads is emerging as a viable channel for practices targeting younger demographics.
What happens to my campaigns if I leave the agency?
If the account is in your name, you take everything with you: campaign history, conversion data, keyword performance, audience data. If the account is in the agency’s name, you start from scratch. This is one of the most important questions to clarify before signing. Always require account ownership from day 1.
What is a negative keyword list and why does it matter?
A negative keyword list tells Google which searches should NOT trigger your ads. Without it, a dental implant campaign will show ads for “DIY dental implant kit,” “dental school free care,” “dental assistant job openings,” and dozens of other irrelevant searches. Every click costs money. Negative keyword management is one of the fastest ways to reduce wasted spend and improve campaign efficiency.
Can I manage PPC myself instead of hiring an agency?
You can set up a Google Ads account and launch a campaign independently. The challenge is that healthcare keywords are competitive, the margin for error in campaign structure is small, and effective optimization requires reading search term data, adjusting bids, testing ad copy, and managing landing pages continuously. Most practices that try self-managed PPC spend significantly more per patient than they would with experienced management, simply because the learning curve is steep and expensive.
What Arcane Marketing Does Differently
Arcane Marketing manages Google Ads campaigns across healthcare practices nationally. Over 100 dental practices alone have trusted Arcane Marketing with their paid search. The reason the $4.14 return is real is structure: campaigns built around high-intent keywords, service-specific landing pages, call tracking from day 1, active negative keyword management, and monthly reporting that explains performance in plain language rather than burying the numbers in charts.
Google Premier Partner status matters here because it is not self-reported. Google awards it based on campaign performance across the portfolio of clients. You cannot buy it or fake it.
Arcane Marketing also runs PPC as part of an integrated strategy. A practice running Google Ads while also building SEO authority, posting consistent social content, and producing video is compounding its visibility across every channel a prospective patient might encounter. PPC fills the schedule. The rest of the system builds the reputation that converts clicks into long-term patients.
