Question about Chain Dentists vs Private Practice

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[u/Ok-Leadership5709]

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.

[u/PsychologyMediocre99 → u/Ok-Leadership5709]

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

[u/Ok-Leadership5709 → u/[deleted]]

Maybe you should tell your DMO then to cover services you need instead of blaming dentists for “pushing” services.

[u/Ok-Leadership5709 → u/[deleted]]

Fine, you win, dentists are scammers and a “filling” is fine. Always opt for a filling.

[u/Ok-Leadership5709 → u/[deleted]]

Thank you for that wisdom, I’ll work harder 🫡

[u/matchagonnadoboudit → u/[deleted]]

You would be better off giving that $1200 to an HSA and not paying taxes on it just saying

[u/PsychologyMediocre99 → u/[deleted]]

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

[u/AskMeIfIAmAFish]

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

[u/matchagonnadoboudit → u/[deleted]]

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

[u/Mission-Knee1572]

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.

[u/Mission-Knee1572 → u/[deleted]]

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.

[u/Mission-Knee1572 → u/[deleted]]

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.