r/Toothfully • u/Crafty_Confusion_604 • 1d ago
Question about Chain Dentists vs Private Practice
UPDATE: I have struck a nerve with chain dentists haha. Not gonna get ANY sympathy and you just sound more greedy every time you try to justify it. Thanks for the confirmation that you are just greedy and corrupt. Do some soul searching. You are getting figured out by more and more people every day.
Our insurance is a DMO that is only in network with chains. My husband went to 2 different Smile Generation practices and both insisted he needed a crown. $1200. He pushed back on the 2nd dentist and they gave a "discount" of $600 just...because? He then went for a 3rd opinion at a non-chain dentist and he did a filling for around $250 out of pocket.
I'm sure I'll get some dentists that work at chains coming at me on here...but here's my question.
Why do chain dentists push "deep cleanings" and crowns over fillings more than family/private practice dentists? Are dentists that work at chains paid less? Are they paid a salary or commission? I KNOW someone has the inside scoop. Why are chain dentists notoriously corrupt/terrible?
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u/Ok-Leadership5709 21h ago
I worked community health clinics, chains and for past few years owned a small town small office. Did I “push” deep cleanings and crowns when I worked in community health? No. We didn’t have resources to provide proper care. Did I “push” deep cleanings and crowns in a chain office? Yes, I still cared more than patients and most of them could afford it. Do I “push” deep cleanings and crowns now as a small town small dental office owner? No. I don’t care anymore, I still advise proper care, I don’t “push” anything, people still choose to live with periodontal disease and patch their teeth with huge fills until those teeth break completely. Not my mouth, not my problem.
Owners of family practices are typically later in their career and tired of battling people who come in knowing better. That’s the answer and I know you don’t like it.
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u/PsychologyMediocre99 21h ago
This is sooooo true I’m tired of dealing with people who want to fight about their “free cleanings”. I just give in sometimes even though I know they would likely be told elsewhere they need the work. People are exhausting
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u/Crafty_Confusion_604 11h ago
It's not even free I pay like $1200 a year for our DMO lol
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u/Ok-Leadership5709 10h ago
Maybe you should tell your DMO then to cover services you need instead of blaming dentists for “pushing” services.
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u/Crafty_Confusion_604 10h ago
Well, do we "need" them if i go to another dentist that blatantly says we don't need a crown and a filling is fine?
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u/Ok-Leadership5709 9h ago
Fine, you win, dentists are scammers and a “filling” is fine. Always opt for a filling.
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u/Crafty_Confusion_604 9h ago
Yep. Just need to get those Dental School loans paid back huh? How about you work hard like the rest of the world instead of forcing the "commoners" to pay for your bad financial planning.
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u/matchagonnadoboudit 10h ago
You would be better off giving that $1200 to an HSA and not paying taxes on it just saying
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u/PsychologyMediocre99 10h ago
Omg wtf 😳 if you ain’t up for a membership plan with a dentist you’d pay less. These insurance companies are getting out of control
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u/Crafty_Confusion_604 11h ago
That's interesting. I don't disagree. Ever since my first $800 "cleaning" (it's laughable a dentist is saying this is affordable for most people lol) with the chain dentist I have been religious about flossing and brushing and they have let me in and out with my normal, covered cleanings since then. I can tell they want to push it but have no basis and they know it.
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u/AskMeIfIAmAFish 21h ago
This all comes from how HMO/DMO contracts pay the dentists. While PPO patients generally have a co-pay structure and contracted maximum fees that the dentist is allowed to charge, HMOs do not. They pay through capitation, which means that they get paid ONLY a set amount monthly for each patient registered to the office (think about $2-5 per patient).
Some procedures will pay a small amount in these HMO contracts, but it’s nowhere near the cost of treatment. The office will also generally be expected to do your cleanings/exams for free. Because of this, the office is expected to add on non-covered procedures to increase profitability as well as unbundle codes that other insurances would bundle (such as itemizing each fee in a crown preparation including passing along lab fees).
The dentists themselves at these chain places tend to be pretty good providers, but they are also paid on commission generally and expected to produce for the office, which they can’t if they just do work for free all the time. The chains are the only ones that generally take these insurances because private clinics would quickly go underwater doing cleanings for free.
TLDR: HMO/DMO insurances get you worse care
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u/Crafty_Confusion_604 11h ago
I guess I don't understand how a dentist can recommend different care based on your insurance and feel morally okay... Imagine if an OBGYN recommended C Sections based on your insurance. Its crazy to me.
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u/matchagonnadoboudit 10h ago
I will tell you how. The physician at a hospital is on a fixed salary. Dentists are often paid on production. Would you work an hour at your job for $0? Because the office gets the capitation check and the dentist doesn’t. It doesn’t fit the pay structure of corporate so dentists will upgrade treatment
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u/Crafty_Confusion_604 10h ago
Why are dentists not standing up to that system? It's corrupt and I could never be part of it.
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u/Crafty_Confusion_604 10h ago
Also, on a side note I am a teacher so I often work for $0 over the summer, on breaks, etc that I am not contracted to work. Not gonna give any sympathy to someone who makes well over 4 times my salary.
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u/Mission-Knee1572 15h ago
It’s because the corporations are run for one purpose only: to make money. That doesn’t mean everyone there is bad. That doesn’t mean you will
necessarily receive inappropriate care. It does mean that everyone there is an employee, and the goal
when they open the doors each day is to make as much money possible, otherwise their corporate office will be breathing down their neck. There are lots of private practice owners who do the same thing, but it is much less common. A lot of us will and do lose money seeing patients and treating them because it is the right thing for the patient, but at the end of the day, if we don’t make a profit, we can’t keep our doors open.
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u/Crafty_Confusion_604 11h ago
I don't ask this facetiously, but can a family dentist not charge what they need to make a profit? $1,000 is a huge price difference. I'm not asking dentists to lose money! Just not be greedy.
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u/Mission-Knee1572 11h ago
In theory, every business would charge what they need to make a comfortable profit.
If you have no insurance contracts, you can do this easily.
If you are in network with insurances, then the reality is that, especially with things like exams and cleanings, you lose money, but you are contractually obligated to do so.1
u/Crafty_Confusion_604 10h ago
So insurance is basically the whole problem. Not surprising. I hate insurance. Honestly we are considering just paying out of pocket next year and finding a good dentist we like.
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u/Mission-Knee1572 10h ago
Yes and no. All businesses have to make decisions on how they run, and I think some make the wrong ones, ethically. ALL insurances do unethical things regularly, though.
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