What is a practice-within-a-practice structure for Delta Dental, and when does it make sense?
A separate business entity with its own tax ID and an employee dentist designated as a non-Delta-participating provider, set up alongside the original Delta-participating practice. The structure lets the doctor accept Delta cases through one entity and non-Delta cases through the other, providing flexibility on which fee schedule applies to which case. Delta’s contract has not historically prohibited this arrangement, though the fine print should be checked carefully and a local attorney should confirm the structure under state law. The setup adds operational complexity: two entities to maintain, two billing systems, careful patient routing, and ongoing compliance attention. For the structure to make economic sense, the doctor needs roughly twenty cases a year that average around twenty thousand dollars each, with the non-Delta routing producing meaningfully higher net revenue than the Delta-contracted alternative. Practices below that threshold typically find the operational overhead exceeds the gain. Practices above it gain real flexibility. Either way, the legal review is non-negotiable.
If the answers you are finding here resonate with you, my team and I work with a small group of clients each year. The next step is a complimentary Discovery Consultation and Practice Review with Dr. McAnally.