Blog - Page 74 of 310 - The McAnally Selling System

Can You Bill Full Fee After the Insurance Maximum?

james2026-06-16T00:00:00-04:00

Can I bill full fees after a patient hits their insurance maximum? In a lot of states, yes, and you may not know it. Roughly 32 states have passed laws saying that once a patient blows through their annual maximum, every service after that can be billed at your routine full fee instead of the contracted rate. Insurance companies fight this hard with workaround language, and for very large self funded employers the federal ERISA picture muddies things, but for smaller plans the state rulings often hold. The catch is nobody hands you this answer. I've seen dentists ask their own [...]

Can You Bill Full Fee After the Insurance Maximum?james2026-06-16T00:00:00-04:00

Stuck With PPO Contracted Fees After the Maximum?

james2026-06-16T00:00:00-04:00

Why am I stuck with contracted fees on a PPO patient after their maximum? Because that's the trap most PPO contracts are written to spring. You hit the patient's 1,500 or 2,000 dollar annual maximum, and the contract still forces you to bill every dollar past that at the discounted rate. On a routine filling that's annoying. On a full mouth rebuild it's fatal, because you're carrying enormous risk and the margin simply isn't there to make the case pay. A lot of dentists just quietly eat it or turn the case away. You don't have to. There are real solutions, [...]

Stuck With PPO Contracted Fees After the Maximum?james2026-06-16T00:00:00-04:00

Separate Business Entity for Big Implant Cases

james2026-06-16T00:00:00-04:00

Can I set up a separate business entity for my big implant cases? Yes, and it's one of the cleanest ways to handle large cases when you don't want to leave a plan that dominates your market. You create a separate business with its own tax ID, and the dentist treating under that entity is a non-participating provider. The big cases get done outside the contract while your main practice keeps the everyday insured flow. I'll be blunt about the threshold though. This only makes sense if you're already doing real volume, something like 20 cases a year at 20,000 to [...]

Separate Business Entity for Big Implant Casesjames2026-06-16T00:00:00-04:00

Should You Drop Delta Dental From Your Practice?

james2026-06-16T00:00:00-04:00

Should I drop out of Delta Dental? Only if you're going to become a genuine student of marketing, otherwise stay put. I withdrew from every Delta plan in my own practice years ago and got a three page hate letter from their president for it. I'd do it again. But I won't pretend it's right for everyone. In some markets Delta owns 80 or 90 percent of the contracted dentists, and that patient flow is real. If you're not prepared to replace those new patients yourself through your own marketing, dropping the plan will hurt you more than the plan does. [...]

Should You Drop Delta Dental From Your Practice?james2026-06-16T00:00:00-04:00

Presenting DMO Treatment Options the Ethical Way

james2026-06-16T00:00:00-04:00

How do I present treatment options to a DMO patient ethically? Treat the DMO patient exactly like any other patient, with one honest twist. Start at the initial exam or at hygiene and give them a real choice. Frame your out of pocket fees before you ever get into a major presentation, so the number isn't a shock at the end. Show before and after digital preview images. If you're presenting two or three crowns, the patient has to see what the finished result looks like, or you're shooting yourself in the foot. Then lay out the best option, the very [...]

Presenting DMO Treatment Options the Ethical Wayjames2026-06-16T00:00:00-04:00

Out-of-Pocket Treatment for a DMO Patient Explained

james2026-06-16T00:00:00-04:00

Can I offer out-of-pocket treatment to a DMO patient? Yes, and most dentists never read far enough into their own contract to realize it. Check your provisions. Almost all of them say that once you have told the DMO patient which option the plan covers at no cost to them, you are free to present every other option at your regular out of pocket fees. If you can't find that language, write the plan administrator or president directly and get it in writing. They almost always say go ahead, because if the patient elects something better, the plan pays nothing and [...]

Out-of-Pocket Treatment for a DMO Patient Explainedjames2026-06-16T00:00:00-04:00

Write Your DMO Administrator a Contract Letter

james2026-06-16T00:00:00-04:00

Why should I write to a DMO administrator about my contract terms? Because a letter turns a guess into ammunition. Too many dentists assume their DMO forbids presenting better treatment, and they never actually confirm it. If you read your provisions and can't find clear language saying you're free to offer out of pocket options once you've shown the covered option, don't shrug and move on. Write directly to the administrator or the president of that DMO and ask. Get the answer in writing. The likely response is that they're delighted, because if a patient chooses treatment out of their own [...]

Write Your DMO Administrator a Contract Letterjames2026-06-16T00:00:00-04:00

Present Out of Pocket Options Without Selling Patients

james2026-06-16T00:00:00-04:00

How do I present out of pocket options without making patients feel sold to? Lead with honesty and give them a real choice, not a pitch. The line between guiding and pushing is whether the patient feels you're recommending what they actually need. Give the choice early, at the initial exam or at hygiene, so it never feels like an ambush at the end. Frame the fees and out of pocket costs before you walk into any major presentation, so the numbers aren't a surprise sprung on them. Show options, before and after images, a digital preview of the result. None [...]

Present Out of Pocket Options Without Selling Patientsjames2026-06-16T00:00:00-04:00

Offering Better Treatment Options to DMO Patients

james2026-06-16T00:00:00-04:00

Can I offer better treatment options to patients on a DMO plan? Usually yes, and most dentists never check. The complaint about DMOs is always the fee, but the real issue is the contract, and most doctors have never read theirs closely. Pull your provisions. The majority say that as long as you've shown the patient the option the DMO covers, the one where the patient pays nothing, you're then free to present every other out of pocket option at your regular fees. If you can't find that language, write directly to the administrator or president of the DMO and get [...]

Offering Better Treatment Options to DMO Patientsjames2026-06-16T00:00:00-04:00

The Insurance Promise: Put Your Guarantee in Writing

james2026-06-16T00:00:00-04:00

What is the insurance promise and why put it in writing? It's a guarantee that kills the patient's biggest insurance fear, and writing it down is what gives it power. The promise is plain. Do a large case with me and you'll get your insurance benefit, and if you somehow don't, I apply what the insurance would have paid straight to your treatment plan. Spoken, that's a nice sentiment. In writing, it becomes a real differentiator the dentists around you won't even understand, let alone copy well. You can put it in your consultation materials and your patient information. One caution. [...]

The Insurance Promise: Put Your Guarantee in Writingjames2026-06-16T00:00:00-04:00

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