How to Grow Without Adding More Insurance Plans

Intro: This is The Thriving Dentist Show with Gary Takacs, where we help you develop your ideal dental practice—one that provides personal, professional, and financial satisfaction.

Gary Takacs: Welcome to another episode of The Thriving Dentist Show. I’m Gary Takacs, your podcast co-host. We have a really cool episode for you today. It’s titled How to Grow Without Adding More Dental Insurance Plans. I think you’re all going to appreciate the content in this particular podcast episode.

But before I get to that, a couple of announcements to make. Coming up shortly after this episode is published, we have another Thriving Dentist virtual event. This one’s coming up on January 17th, and we are going to have a panel discussion. We’ve invited a number of experts, and the topic for that panel discussion is Future Ready Strategies for Your Dental Practice—in other words, how to get your practice ready for the future.

Come join us. Those Thriving Dentist live events are offered at no tuition. That’s our gift to you in appreciation for your listenership.

But you do have to register for those. If you want to register for any of our virtual events, go to thrivingdentist.com/events.  The particular event that’s there when you click on that link will be the next one in the calendar. So if you’d like to attend Future Ready Strategies for Your Dental Practice, be sure to go to thrivingdentist.com/events,  and we’ll look forward to seeing you there.

The second announcement I have is we have a new contributor. We like to invite many of our listeners to contribute to The Thriving Dentist Show, and we have a new contributor. His name is Dr. Darryl Burke, and he’s going to share his concepts about how to thrive in dentistry through the changes in our profession. Very appropriate topic, and I think you’re really going to appreciate Dr. Darryl Burke’s perspective.

No further ado—here’s How to Thrive in Dentistry Through the Changes in Our Profession by Dr. Darryl Burke.

Dr. Darryl Burke: Hi, this is Darryl Burke of the Burke Implant Academy. Are you feeling the pinch right now? Maybe you’re an associate or a clinician being pushed to produce more, faster, every single day. Or maybe you’re a practice owner watching profits tighten, even though your schedules are full.

The truth is, you’re not alone. Rising overhead, shrinking insurance reimbursements, and higher staff costs and supply bills are putting pressure on everyone in dentistry right now. But the solution isn’t just to work harder or cram more patients into the day. I’ve done it. This will eventually lead to burnout.

The real key is learning how to increase your value, not just your volume. And one of the most powerful ways, in my opinion, is through surgical implant dentistry. When you invest in implant training—and you do it the right way, with proper mentorship, the right technology, and solid, proven systems in place—it will completely transform your practice.

Dr. Darryl Burke: You stop referring out, you keep your patients in-house, you offer more comprehensive care, and your patients appreciate that trust and continuity. Implant dentistry doesn’t just add production—it elevates your entire practice and brings back the excitement of being able to help your patients. That goes way beyond restorative dentistry.

Think about it. One well-planned implant case can produce the same as several smaller procedures, but with far more impact and far less stress on your schedule. Yes, it takes an investment because you need to have proper training, which takes time, plus the proper technology to help you get there. But that investment pays you back many times over in both professional satisfaction and profitability.

I know this because I’ve lived it. Implant dentistry changed my practice, my confidence, and my outlook on this profession. That’s exactly why I started the Burke Implant Academy—to help other dentists experience that same transformation.

Dr. Darryl Burke: We help from placing that very first implant to your very first All-on-X. If you continue down your surgical implant journey, the main emphasis is to properly teach you to pick and choose cases within your comfort zone, because complications will arise, and you need to be able to handle them.

Whether you’re feeling the squeeze as an associate or watching margins shrink as a practice owner, learning surgical implant dentistry can help you take back control, grow your production the right way, and make dentistry exciting again. So don’t just chase numbers. Invest in yourself, your skills, and your future. Because when you do, your patients win, your team wins, and your practice will thrive.

Thank you.

Gary Takacs: Well, welcome back to The Thriving Dentist Show. I want to thank Dr. Darryl Burke for adding his insights on how to thrive even though things are changing. We appreciate all the different perspectives, and I certainly appreciate his, and I hope you do as well.

Hey, as I mentioned, this is going to be a fun episode titled How to Grow Without Adding More Dental Insurance Plans, and I know this is going to be of keen interest to all of our listeners. You know how we feel about dental insurance because of the way the insurance setting your fees does not usually work well in your favor. But there are some dentists that think it’s a perplexing problem—how are you going to grow if we’re not going to accept insurance plans?

Gary Takacs: That’s a fair question, and Naren and I are going to unpack that for you today, because, in fact, we can speak with confidence that you absolutely can grow your practice, all the while reducing your insurance footprint. It seems a little counterintuitive, but in fact, we can say that with confidence.

Why can we say that? Because we do it every day with the Thriving Dentist coaching clients—how to grow and reduce the insurance footprint at the same time. So, if that’s a topic that’s of interest to you, you are in the right place. Naren and I will just have a great conversation around this. And again, the topic is How to Grow Without Adding More Dental Insurance.

Naren, what do you think about this topic?

Naren Arulrajah: Yeah, Gary, I think it’s an excellent topic, and I think it’s a timely topic. This is getting published in week two of 2026, so a lot of people are really thinking about 2026 as a whole and trying to figure out where to focus, what to do.

And I think the unfortunate thing about at least 80–90% of insurance plans is, if you’re doing, you know, a hundred dollars’ worth of dentistry, you only get to keep $50 or $60, which means you’re kind of starting in a negative hole—almost like you’re digging out of a hole. So if you can grow without adding insurance, that means you’re not creating an additional hole as you grow your revenue.

So it’s a great way to think about this, and I really think, Gary, including that clinical tip from Dr. Burke, it’s a wonderful episode, and I’m sure people will be very keen on taking a lot of notes and hopefully applying some of what we’re going to talk about today.

Gary Takacs: Yeah. We’re kind of challenging what is common wisdom in dentistry. Common wisdom is just sign up for more plans if you want to grow.

Well, common wisdom can sometimes be very faulty. And in this case, I would suggest that that common wisdom is very faulty.

Naren Arulrajah: I think in the 1960s, it was probably a great idea, but today insurance doesn’t pay what it used to compared to the 1960s. So you’re right—it is very faulty. In 2025, I totally agree with you, Gary.

Gary Takacs: 2026.

Naren Arulrajah: Yes, yes. We gotta remember we’re now in the new year.

Gary Takacs: Yes.

Naren Arulrajah: So I do want to kick this off by asking you a question, Gary. The data shows that the majority of dental practices want to reduce their insurance dependence. We see this in the overwhelming demand for the Reducing Insurance Dependence Academy, the summit, and even our sister podcast, The Less Insurance Dependence Podcast Show, where people really have an appetite—because they’re just sick and tired of the same old games, right?

Fighting with insurance companies to get paid, and insurance companies dictating what they can do, et cetera, et cetera. So there’s a huge demand for this.

But the fear that keeps many people still stuck with a dozen, two dozen plans is the fear of losing patients. So you have been a coach now—I believe this is your 40…

Gary Takacs: Well, we’re in year 46, Naren.

Naren Arulrajah: 46. Yeah. You have been doing this for 46 years. So from a practice management perspective, as a practice management coach, how can practices think about reducing their dependence on insurance while growing the practice—meaning practice revenues, practice profits—at the same time?

Gary Takacs: Yeah, Naren, I want to—I’m going to answer that question, but before I do, I want to back up something you said. I want to back it up with data. You said the majority of dentists want to reduce their insurance dependence. And by the way, that’s not just our opinion. That’s not just an opinion from us.

The Health Policy Institute (HPI) published some recent data on this, saying that two-thirds of dentists in the United States, in their research, were going to resign from at least one dental plan coming up in the next six months—two-thirds. So now this isn’t just like an opinion or perspective. Literally, two-thirds of dentists are saying "enough," and they’re making a decision to resign from at least one plan in the next six months.

So, back to your question: how can our listeners reduce insurance and still grow the practice? I think, you know, that’s the—remember that game show way back when, Naren, called The $64,000 Question?

Naren Arulrajah: ?

Gary Takacs: Well, now we have to adjust that for inflation.

Naren Arulrajah: $64 million question.

Gary Takacs: Yeah, but I’ll adjust it—that’s the $640,000 question. Because, believe it or not, that’s what many offices are writing off every year by insurance.

Naren Arulrajah: Yes.

Gary Takacs: So, great question. And you know, dentists need to recognize that we’ve got to measure the right things. We often measure things that we think are important, like how does their schedule look? Is their schedule full?

You know, can we agree that looking at the schedule is perhaps a little bit of a barometer of some sorts, right? Is your schedule full? But if it’s full of insurance patients—PPO patients—that every time you treat them, you pay 45% of your revenue to treat them, in fact, you’re losing money. You’re losing money.

So we’ve got to remember to measure the right things. And, you know, the truth is that you can attract people for other reasons than being on their insurance.

Think about it—we actually have something working on our side that many dentists think is problematic. And what I’m talking about is services that are not covered. So things that are not—and most PPO plans are reducing the kinds of things they cover. Most elective services are not covered. Things like Invisalign, or adult orthodontics, cosmetic dentistry, dental implants—that stuff’s not covered.

And while dentists look at that and say, “I wish the insurance companies would cover that,” I actually think the other way. I’m glad they don’t cover it, because now we can charge our full fee for those services.

And part of the way to navigate this is to develop a marketing strategy and a reputation that allows people to choose you—or motivates people to choose your office—for reasons other than being on their insurance. Because you’re not.

So, you know, if you want to reduce insurance plans, we’ve got to build some good systems in place in your practice.

Gary Takacs: Let me just rattle off four right now—four systems.

One, we need a really healthy hygiene department. You’ve heard me talk about being a hygiene-driven practice. It’s more important than ever. And I know many offices struggle with it now because of the hygiene wages. If your hygiene wages are stratospheric and you’re subjected to 45% discounts, you’re probably losing money in hygiene.

I’ve actually received many emails from doctors that say, “Hey Gary, in 2025—now, 2026—does it even make sense for me to have hygiene in my practice? Because I’m losing money every time I see a hygiene patient.” Great question, but I’m going to answer it very boldly: yes, it makes sense for you to have a hygiene department.

Because, number one, it’s going to keep our patients healthier. And number two, those hygiene appointments lead to exams, which lead to treatment in your schedule. So we want a stronger hygiene department, and it’s more important than ever to have that.

Now, let’s address the losing money part. But yes, we need that department to be there.

Secondly, we need a well-trained administrative team. Who’s going to field most of the questions about insurance? It’s going to be your admin team. So your admin team needs to have really good training.

When someone says, “Hey, I’m interested in having those veneers done. Is my insurance going to cover veneers?”—and if your admin team says, “Nope, it’s not covered,” that might be the end of the conversation, right?

But if she says, “Well, unfortunately, your insurance company doesn’t cover that, and that’s really lousy of them”—and I would use that same language: “That’s really lousy of them not to cover it. But if you think about the benefits of having a beautiful, attractive smile, I think you’ll realize that the benefits to you are absolutely worth having this kind of dentistry done. Let me show you some patients we’ve helped.”

And then imagine pulling out an iPad with befores and afters, Naren. And now the patient might say, “Well, I guess I have to pay for it myself, but I’m interested.”

Do people pay for things that aren’t free? That aren’t given free? Sure.

Naren Arulrajah: Yes.

Gary Takacs: I mean, otherwise, in travel—if people only went where it was the least expensive—all we would have is budget hotels.

Naren Arulrajah: Exactly. How many people clean budget hotels? Very few people, right? Actually, the funny thing is, more people would rather pay double the money for a decent hotel versus the cheapest motel that’s out there.

Gary Takacs: Right. You know, in the auto manufacturing business, if people only wanted the cheapest car—I don’t even know what the cheapest car is anymore. I used to say Yugo. I think Yugos are long gone. But I’m not sure—I don’t want to offend any manufacturers.

Naren Arulrajah: Corolla is the cheapest Toyota, for example.

Gary Takacs: Well, you know, they sell a lot of Corollas. But they also sell a whole lot of loaded-to-the-gills Camrys. And they sell a whole lot of 4Runners and Toyota Land Cruisers, which can be six-digit cars.

So, to recap—we need a really great hygiene department. We need a well-trained administrative team. We need a great new patient experience. We really want to make an impression, so that when we see the patient for the first time, they’re saying, “Wow, I love it here. I never imagined that a dental office like this existed. And now I know.”

And then, perhaps equally important—or even more important—we need a marketing plan that guides new patients to choose your office for reasons other than you’re on their insurance.

Gary Takacs: So there’s four systems right there. And when you work these things out, we can start working out a plan to resign from a PPO plan step by step—not all at once, but step by step. And that’s how you grow while reducing your participation with insurance. That’s essentially the description of how you do this.

So Naren, I’m going to ask you the next question. From a marketing perspective, what type of marketing is the most effective for a practice that wants to grow without adding PPO plans?

Naren Arulrajah: That’s a great question, Gary. And I do want to comment on what you said. You know, we have seen—both you and I, over the last seven years—many, many dozens and dozens of practices do exactly what the title of this podcast says. They’re growing their practice without adding more insurance plans. And the way they do that is through what you just talked about, Gary.

I know you just gave them the tip of the iceberg about systems. And the other way they do that is through marketing. You kind of said the same thing, you know, a minute ago about budget hotels. How many people stay in budget hotels? Less than 10% of the population.

Gary Takacs: Yeah, some do. I mean, let’s recognize—some do.

Naren Arulrajah: Yeah, but it’s a minority though. That’s the thing we need to understand. Most people today will pay for things they want. And they don’t want the cheapest motel, even though it’s half the price of a decent hotel. Even like a Best Western, right? Literally, you can get a Best Western for, say, $200. You can get Motel 6 probably for like $90. But Motel 6 is empty. If you just look at their parking lot versus Best Western—people are paying double the money for the same size room. Of course, better service, cleanliness, nicer building, nicer amenities, and so forth.

And I think the same is true for dentistry, right? People know free dentistry is what it is—it’s free dentistry. They assume it’s the worst and the lowest quality. So if you’re really willing to think differently and start attracting patients—that’s what marketing does—then definitely you can attract those patients, the 90% of people who are willing to pay for what they want instead of just using free stuff.

So, I’ll start with the basics, Gary. What are people doing?

Healthcare has become extremely important for people, especially after COVID, because we’ve become very aware and conscious of why we need to take care of our health. Most of the people who died had some other underlying condition. They’re like, “Oops, it’s no longer just, ‘I have cholesterol’ or ‘I have diabetes’—but it could literally kill me if something else happens.” That would really accelerate how fast I deteriorate.

So people have taken health very seriously, and we know this based on how engaged people are and how many questions they’re asking.

So what do they do? They go to Google and start looking for things. For example, somebody learns about the oral-systemic connection. They’re asking Google questions about who’s a doctor who can help them with this. Or even something as simple as a beautiful smile—they know there are three or four different ways of taking care of it. They’re Googling those things. They’re looking for those things.

So, if you want to participate in those profitable, high-value services that people are willing to pay for—services like sedation dentistry, Invisalign, implants—then you need to show up. Because if I don’t find you when that particular patient is looking, you’re not even in the race. How do you expect to have any chance of winning that race—i.e., getting that patient?

Gary Takacs: Well, you never made it to the start line.

Naren Arulrajah: Exactly. You never made it to the start line.

So that’s step one I would take, Gary: just showing up for the relevant searches related to the services that I offer. And I want to show up organically because we know people don’t trust ads. And for variations of that search—for example, Invisalign—there might be 45 different ways people are looking for it.

How do we know this? We use Google Analytics, and we literally know there are all different ways people are learning about Invisalign.

So:

• You show up.
• Is the page loading fast enough?
• Is there a phone number to call?
• Is it easy to work with you?

Are you making a good first impression? Are you getting me, as the patient, to like you online before I’m even ready to pick up the phone and call?

And I do think Google reviews play a huge role as well. Because people today don’t want to go to dentists who don’t have 4 or 4.5 stars or above, or who don’t have enough new reviews coming in. Why? Because they know maybe once upon a time you were great, but perhaps something changed and you’re no longer great. So getting those consistent reviews is the other key thing.

I think any listener can do this. You don’t need a marketing company to get 10 or more Google reviews every month. I know, Gary, you coach your clients on how to do this consistently. And we’ve been very successful in helping people get 10 reviews every single month—love letter reviews.

So I really think, go back to the basics. Attract people who are looking for things they’re willing to pay for: Invisalign, implants, sedation, “I’m afraid of going to the dentist”—whatever that is.

Gary Takacs: I’d add, you know, complex restorative dentistry. We call those high-value services, right? So whatever types of services you really enjoy providing—there’s no generic menu for that—you have to pick the stuff you like.

It could be complex, full-mouth restorative dentistry. It could be treating TMD/TMJ. It could be diagnosing and treating obstructive sleep apnea with appliance therapy. Those are things people are seeking out. And then by doing the right marketing, you’re going to be the office they find when they’re seeking it out.

Now, let’s remember—I used to say that the first impression a patient would have of your practice was when they called your office. And the first impression was on the phone.

I don’t believe that to be true anymore, Naren. I believe that to be the third impression. Let me explain.

Gary Takacs: I think the first impression is when they find you in a Google search and they go to your website. So your website’s the first impression. And if your website doesn’t look like you have the capabilities of providing what they’re looking for, then they’re going to keep looking. If it doesn’t look like it meets their expectations, they move on. So your website is key here.

So first impression: the website. Now, let’s assume you do have a great website. You have a marketing company like EWA that’s designed a great website for you, and there you go—you have it.

The next thing they’re going to do is take a look at some of your reviews. They won’t look at all of them, but they might look at two or three of your reviews. Yes.

So think about this order:

• First, they found you.
• They went to your website.
• They liked what they saw on the website.
• Then they looked at two or three reviews.
• They loved what they read in the reviews.
• Then they pick up the phone and call you.

That’s the buyer’s journey today. So by the time we get to the phone call, it’s a third impression. But by the way, that impression could completely bomb out if we’re not answering the phone right.

Naren Arulrajah: Absolutely. Got it.

Gary Takacs: Yeah. So this whole idea of really getting your marketing sequencing in order—with all the different components that go along with it—is very, very important.

Naren Arulrajah: Gary, I want to kind of continue on our conversation here. And this is something that I know a lot of dentists—because unfortunately for most of us humans, we are motivated by fear more than the opportunity to do something different and make our life better.

So one of the questions I get a lot, and I’m sure you have seen this, is: “My competitors are advertising low fees. How do I stand out in this environment of people trying to sell low-this, low-that, discount this, deal here, deal there—without joining the race to the bottom?”

And it also reminds me of a chat you and I had, Gary, about what we learned with Groupon patients, right? So I’d like to hear your thoughts on this. How do you think about it? How do you advise your clients—having done this 46 years?

Gary Takacs: Well, don’t participate in the race to the bottom.

Naren Arulrajah: Right? Don’t.

Gary Takacs: Because it is a race to the bottom. You could win that race, yeah—but are you really winning?

Naren Arulrajah: Like Starbucks—it’s a great example. Will Starbucks ever sell a $1 coffee? I’m sure they can.

Gary Takacs: Yeah, and I don’t think we’ll ever see it on the menu.

Naren Arulrajah: Yeah, exactly.

Gary Takacs: But it’s a race to the bottom, right? And I understand—in every major city, you can see billboards offering dental implants. It’s a little bit of a trick question. It’ll say “Dental implants as low as $999.” Right? “999.” Dental implants as low as—in tiny fine print—$999.

And it is literally a race to the bottom. Don’t participate in that.

Offices that are in the Southwest—in Southern California, Arizona, New Mexico, parts of Texas—we have this demonstrated very poignantly because there is an element of our population that will choose to go across the border to Mexico to get their dentistry done.

In Arizona, we have a town in southern Arizona called Nogales, Arizona. And there’s a town right on the other side of the border—Nogales, Sonora, in the Mexican state of Sonora.

Naren, I don’t know if you’ve ever been there—I doubt you’ve been to Nogales.

Naren Arulrajah: I haven’t been.

Gary Takacs: Yeah, but let me tell you what you’ll see. It’s ten times the size of the Nogales, Arizona town. The U.S. town is a little tiny town. The town in Mexico is actually a big town.

But the first three streets—all you see are Dentista and Pharmacia. So dentist and pharmacy.

And I went down there before COVID, in 2019, because I wanted to research this and kind of see what it was all about.

Naren, they may not have these in Mississauga, but do you have sign twirlers? You know, people who stand on the corner and twirl a sign? That’s their marketing. It’ll say "Pizza $7" or "Car Wash $3."

Naren Arulrajah: Actually, we don’t see this as much in Mississauga, but I have seen it. I know what you’re talking about—especially in certain cities in the U.S. I’ve noticed it.

Gary Takacs: Yeah, yeah. It’s usually low-cost services, like car washes or pizzas, stuff like that.

But anyway, there was a sign twirler that had a sign made in the shape of a tooth—a shape of a molar. Imagine a big sign shaped like a molar—and he was spinning it to get attention.

And when he stopped spinning, I looked at it and it said—this is 2019, let’s put that in perspective—“Crowns $150.” That was 2019, Naren. A crown for $150.

Now apparently, one of his buddies came up—because I have this on film. One of his buddies came up, looked at his sign—he also had a molar sign—and his sign also said, “Crowns $150.” So he took out a wide-tip marker, crossed out the $150 on his sign, and wrote—wait for it—$149.

Gary Takacs: Clearly, that’s where we should go, right?

But no—just don’t play the game. Just don’t participate in the race to the bottom.

Naren Arulrajah: It’s a slippery slope, right? It’s kind of one of those—what do they say? If it’s too good to be true, it’s too good to be true.

Gary Takacs: Probably is. It probably is. And, you know, you stand out with trust. How you stand out is with trust.

The voices of your patients—Google reviews—can help you stand out. Imagine someone saying, “I would never go anywhere else for my dental care than here, and here’s why.” Maybe they rattle off four or five things.

And if you can build a magnet—attracting people because they trust you—that’s way more powerful than price. There’s always going to be someone who can offer a lower price. Do you agree with that, Naren, business-wise?

Naren Arulrajah: I agree.

Gary Takacs: Always someone that can have a lower price. But do you even want to play the game?

Does that low-cost provider invest in technology? Do they have the best team members? Do they have amenities of any sort at all? No.

Do they stand behind their work? Likely not.

The only thing they’re offering is the cheapest price.

And I would suggest the simple answer to that is: develop a different marketing plan. For sure.

So Naren, I’ll ask the next question. Many dentists wonder if it’s realistic to build a fee-for-service-based practice in a PPO-heavy market. You know, many of the urban areas in our country are very saturated with PPO practices.

So what can marketing do to make it possible for them to compete in a very crowded market?

Naren Arulrajah: Yeah, so I’ll answer the first part of the question, Gary—is it possible? Absolutely. And I’m just going to literally look at one of our client’s reports and give you some numbers that tell the story. You know, information is—real data is—powerful, right?

So this particular client started with us around 17 months ago. We’re getting 140 total calls and around 25 new patient calls.

Gary Takacs: Now explain that—explain the difference between the 25 and the 140.

Naren Arulrajah: Yeah, so we put a specific tracking number, and we call it the new patient number. So we only expect new patients to call it, but the reality is people are lazy. Even existing patients will use Google, and they will find that number—even though it’s clearly marked as a new patient number.

So even though they’re getting 140 calls, 25 of them are actual new patients and the others are not. So we figure that out by listening to the calls and categorizing all the calls coming in—how many are new patient calls.

And this particular practice is converting approximately 75% of those calls. So out of the 25, they are booking approximately 20 new patients every single month.

Gary Takacs: Converting means that there was a new patient that called and scheduled a new patient appointment.

Naren Arulrajah: Exactly. Exactly.

So let’s do some math, right? At the end of the day, life is math. I know one of our mutual friends who’s a CPA taught me that quote.

So those 20 patients, and they spend $1,250—it’s costing them an average of $60 per new patient.

Now these patients—they didn’t go because they were on a PPO plan. They went because they typed in a word like implants, they typed in a word like sedation, they typed in a word like Invisalign—the particular services that this practice provides. Even just general dentist, family dentist—so they’re looking for a good quality dentist that they’ll be happy with. And they find these practices on Google.

So, $60 per new patient.

And these patients—unlike a PPO patient—the way a PPO works is, you get a patient from a PPO plan, and that plan pays, let’s say, 60% (I’m being generous here). So you get $1,000 paid by the insurance company, but you’re doing $1,500 worth of dentistry. So in that first year, your “marketing cost” is $500.

With this SEO-driven patient, your marketing cost is $60.

Now, the unfortunate thing about the PPO patient is—in year two, you’re still paying that $500 fee. Why? Because that same patient is still with the same PPO plan. So in the second year also, they’re reducing fees, controlling your fees, and doing all this hanky-panky.

So for the life of that patient, you’re paying $500 year after year in “marketing fees”—as opposed to the SEO patient, which is $60, one-time.

Gary Takacs: Naren, let me introduce a word that I think will affect our listeners. It’s one word that probably inspires more anger and more energy than any other single word in the vocabulary. Would you like to hear what that word is?

Naren Arulrajah: Yes, please.

Gary Takacs: Taxes.

Naren Arulrajah: Yes. Yes.

Gary Takacs: How does everyone feel about taxes?

Naren Arulrajah: Yes, I agree.

Gary Takacs: Everyone—you know, the blood, your blood is boiling, right? So think about that fee you have to pay every time you see a PPO patient as a tax. It’s your PPO tax.

Naren Arulrajah: Right.

Gary Takacs: And, you know, today in 2026, the average adjustment—which is the difference between your usual fee and the contracted fee—is between 45% and 50%. So when you use a 40% number, you’re being very generous, Naren. It’s typically a 45% to 50% adjustment.

And in some states—let me call them out—Delta’s fees are actually going down. I’ve seen some Delta fee schedules recently that had a 60% adjustment. So if you’re doing a service that’s $1,000, you’re not getting $1,000—you’re getting $400. And with your overhead, you’re now paying to see that patient.

Naren Arulrajah: Thank you, Gary. So to complete my answer, the second part of the question was: what can marketing do to make it possible?

So I gave you a case study—$60 a new patient through an SEO strategy versus $500–$600 per year through PPO plans. So definitely, it’s possible, and it changes your math, your equation, your business completely.

Second part of this is: how do we do this?

We talked about—when people are looking for these services, are you showing up? So one of the metrics I would track is: how many keywords are you ranking for on page one of Google?

And the minimum I would recommend is 100. Like LifeSmiles, Gary, ranks for 800 keywords. Of course, we’ve been doing this for seven or eight years now, so definitely time is on our side, and all the work we did in the prior seven years is on our side.

So this can get better and better and better. It’s kind of like the same concept of, you know, the 1% have most of the benefits—same way, the people who dominate Google have an unbelievable amount of benefit in terms of how many new patients they’re able to get without having to spend as much.

And the second portion is Google reviews. Try to get 10 reviews a month—it’s a very simple goal that every one of you should aspire to.

And the third piece that trips people up—and I’m just getting to the most important pieces here—is the call conversion rate. That’s where coaching comes in. The average practice is only booking one out of three new patients.

Sometimes you’re getting enough new patients—and we’ve seen this dozens and dozens and dozens of times—so you’re getting the calls, the new patients are calling you, but they’re not booking.

So here’s a funny story, Gary. One of our mutual clients from a long time ago referred someone else, and that gentleman became a client. And he’s only converting 25%. I mean, literally—25% of new patient calls.

Gary Takacs: One out of four.

Naren Arulrajah: One out of four. And he’s so busy thinking about Google Ads and this and that and everything else. I’m like, stop! It’s a waste of your money. We’re just going to burn money. If you are converting one out of four through SEO, you’ll convert one out of ten through Google Ads—and Google Ads are five to six times more expensive, even if you were really good at converting.

So that’s the third piece. So those are the three things I would focus on:

1. How many keywords am I ranking for?
2. How many reviews am I getting—10 or more 5-star reviews each month?
3. What’s your conversion rate—what percentage of new patient calls are actually booking appointments?

Gary Takacs: Yeah, you’re right.

Naren Arulrajah: I would agree, Gary. I’m going to switch gears and ask you a question as the practice management coach.

From a management perspective, what are the early warning signs that insurance is beginning to take control of a practice?

In other words, it’s kind of like—sometimes you see these parasites, Gary. I mean, I have a house, and sometimes they start growing around the walls and stuff. And at some point, they overwhelm the house or overwhelm the tree that they’re growing on. And it can literally kill the tree, for example. So you have to literally cut everything off.

So when do you feel like the insurance plans are just overwhelming a practice?

Gary Takacs: Yeah, and I’d like to kind of frame it this way. There are some vital signs that we can look at in every practice. It’s kind of like your physician—your primary care physician. They’re going to take your pulse. Your pulse is a vital sign that’s very important, and that pulse tells a lot of information.

Well, how do we take the pulse of your practice to see if you’re getting overrun by insurance?

The single best way to understand if insurance is beginning to take control in your practice is to know exactly how much you’re writing off due to insurance adjustments.

Now, a layperson listening to this—someone who’s not in dentistry—they just heard that last statement. I believe a layperson would respond like this: “Well, duh, doesn’t every dentist know what they’re writing off?”

And in fact, that’s not the case.

Knowing how much you’re writing off is absolutely critical.

Let’s remember—according to accounting norms, there are two ways to enter your fee schedule in your practice management system, whether it be Dentrix, Eaglesoft, Open Dental, Curve—whatever you have.

You can enter your UCR fee, your usual fee, and then the software will do the calculation to figure out what the adjustment is—and then it will show you how much you’re writing off.

But only 10% of dentists enter their UCR fees in their practice management system. Ten percent.

All of the major practice management systems encourage you to do it the other way. Dentrix, Eaglesoft, Open Dental, Curve—they encourage you to enter your contracted fees. “Enter your contracted fees.”

Naren Arulrajah: Right.

Gary Takacs: And 90% of dentists in the United States do that. Ninety percent of dentists have no ability to run a report and see what they’re writing off.

So Naren, when you don’t see what you’re writing off, you don’t know. It’s not in front of you. You don’t see it. It’s like not taking your blood pressure. Not taking a pulse reading. You don’t know. It’s the silent killer.

This is an example I want all of our listeners to etch in their mind. And by the way, we’re not talking about a minor amount.

I use this example because it’s so poignant to help you understand what you’re writing off.

A new client of ours in Thriving Dentist—the first thing we do is figure out what they’re writing off. I asked him, “Do you know how much you’re writing off?”

Gary Takacs: He said, “No, I enter my contracted fees, so I don’t know.” And I said, “Well, we can help you figure that out.”

This is an office that, at the beginning of 2025 when they started working with us, had collected right at a million dollars the previous year—2024. It was actually a million and a few hundred dollars, but we rounded it to a million dollars.

And I said, “Do you know how much you’re writing off?” He said, “No, I don’t.”

So we ran it through a spreadsheet we developed—a kind of proprietary spreadsheet—and we discovered that in order for him to collect a million dollars, he had to produce $1,565,000.

Naren Arulrajah: Right?

Gary Takacs: So how much is he writing off, Naren?

Naren Arulrajah: Uh, $564,000?

Gary Takacs: $565,000—yes.

So if you accept my definition that your write-off is a marketing expense, I want you to think of it as a marketing expense.

Why do I want you to think of it that way? Because you’re paying the insurance company to provide you patients. You’re paying them a tax every time that patient comes in, right?

So there—in that $565,000 annualized—if we divide that by 12 months, what is that doctor paying per month?

I’m using “paying” in air quotes, because you’re not actually paying it to Delta. It’s even worse—they take it before you ever got it.

How much are they spending every month?

Naren Arulrajah: $47,080.

Gary Takacs: $47,000 per month. All I did was take $565,000 divided by 12.

Naren Arulrajah: Right.

Gary Takacs: $47,000 a month.

Do you know anybody that actually spends $47,000 a month on marketing?

Naren Arulrajah: No.

Gary Takacs: In dentistry?

Naren Arulrajah: No.

Gary Takacs: But many, many, many practices are.

Naren Arulrajah: Exactly.

Gary Takacs: So you need to know what that number is. Because if you don’t know what that number is, you are literally driving blindfolded.

You’re driving an exotic sports car—that’s your practice—with a set of blindfolds on.

Naren Arulrajah: Right.

Gary Takacs: That scares the heck out of me, Naren.

Naren Arulrajah: I agree, Gary. Yeah, I agree. I think this is one of the things I would recommend everyone does as we lean into 2026: understand the fundamental numbers that drive your practice. And how much you’re writing off is one of those numbers. If you don’t understand it, you are like driving a truck off a cliff. Literally. You don’t know.

Gary Takacs: Yeah.

So, Naren, let’s close on a really positive note—because that was a little heavy there, wasn’t it? But necessary. You have to know what the economics of your practice are.

Let’s close on a positive note.

So we’re at the beginning of 2026. We’ve got almost all the year ahead of us.

Looking ahead to 2026, what is the one marketing shift that will help dentists stay in control and grow the right way?

Naren Arulrajah: Yeah, I think you need to start taking ownership of your practice—which means, start by attracting the patients you want versus taking any patient that insurance sends you. And that really starts by having a strategy: “Here are the services I want to do well in.” Are people who are looking for those services finding me?

Yes, you can do Google Ads, but it is five to six times more expensive. Or invest in SEO, so you’re showing up for those things—dozens and dozens of times—for each service or procedure that you care to focus on. So that’s where I would start.

And then I think Google Reviews—going back to what I said earlier—should be part of every successful practice. Get 10 or more Google reviews.

And finally, you need to know what the key numbers are. We touched on them, including the conversion rate—and just continue to improve those, right?

Like, if I’m ranking for 30 keywords this month: “Hey, Mr. Marketing Company, help me rank for 40 keywords.” I got 5 new patient calls: “Help me get 10.”

So, continuing to improve those numbers. And then, eventually, what will happen is—before the end of 2026—you will be in control, instead of living and dying by this PPO plan that sends you patients you don’t want.

You start attracting the patients you want—and a large number of them. And then you can get better and better, and tweak your strategy. Even, for example, you might say, “Okay, for the next six months, I want to double my Invisalign.” So let’s zoom into that.

You can really custom-build your practice the way you want.

Gary Takacs: I want to leave our listeners with an image, Naren. You know, there are a lot of different formats for dental practices—you can have a freestanding building, you could be in a professional building, you could be in a retail setting, you could be in a mixed-use center.

But imagine you had the type of practice where you could put a sign out front.

I think the best way to begin to change—if you’re a PPO practice—is to think of it this way: If you’re participating with PPO plans, you might as well just put out a big sign out front that says: “FREE DENTISTRY.”

Naren Arulrajah: It’s kind of like the image of the Mexican $149 crown, you know?

Gary Takacs: Free dentistry. Yeah. “Come here!”

And… do you want that patient?

Or do you want the patient whose next-door neighbor had a beautiful cosmetic dentistry case done, and he’s never smiled as much since he’s had that new dentistry? And his friend’s talking to him, and he says, “This is the best thing I ever did. You should go to my dentist.”

Which one do you want?

Do you want the one that comes in because you have a “Free Dentistry” sign out front?

Or do you want the one that chooses you for reasons that are compelling?

Well, you know, Naren, this has been a powerful conversation.

Dentists can indeed take control of their practice in 2026. They need clear systems, strong leadership, strong marketing that builds trust—that needs to be in place.

Gary Takacs: But we can say that confidently because we’ve seen it happen time and time again. And once you make this pivot and reduce your insurance dependence—you don’t have to go all the way to fee-for-service. We call it reducing insurance dependence because you do not have to go all the way. Every time you successfully resign from a plan, you’ve improved your practice.

But you may decide that you want to go all the way. And if you do, then I’m going to be your biggest cheerleader—because that’s the way to get the most out of it. But in some cases, it might make sense to keep a stray plan for reasons that make sense in your community.

So what I would suggest is—if mastering marketing is on your list of goals for 2026—set up a marketing strategy meeting with Ekwa: www.ekwa.com/msm. 

Naren Arulrajah: That is correct—ekwa.com/msm. 

Gary Takacs: Yeah. I’ve referred many clients to Ekwa. I’ve gotten to see the results time and time again. And that example you gave about the cost of a new patient—at $60—makes a whole lot more sense than the tax that you have to pay to the PPO plan.

If you’d like help with coaching—if 2026 is the year for you to tap into coaching—we are accepting new clients at Thriving Dentist. If you’d like to set up a coaching strategy meeting with me, go to thrivingdentist.com/csm.  It’ll be a Zoom meeting where you meet with me, and I’ll have a chance to learn about your practice, share about our coaching, and together we can determine if it might be a good fit.

As we close—Happy New Year to all of you, and here’s to making 2026 your best year yet.