Michael Nugent, D.D.S
Pasadena, Texas Cheap Dentistry:
This is why I hate Corporate Dentistry / Franchise Dentistry Mills. My office Manager Lisa had a relative who thought he could not go to the dentist because he did not have dental insurance. He purchased dental insurance and the only places that took his insurance were the Corporate Chain Dental Clinics. In my opinion these places are horrible for patients and they operate on a sheer volume business model. They take EVERY insurance plan, they go through dentists constantly, patients don’t stay long term and they do a lot dentistry that I do not agree with. These Corporate Dental Chains promise “free exam and x-rays” to get patients in the door. In my experience, these Clinics need to do a lot of work quickly because the work is sub-standard and they treat patients with little to no respect.
Corporate Dentistry wanted to do $ 7,028 worth of treatment. If you are getting a cheap or free examination, the lost revenue has to be made up somewhere.
Lisa’s relative went to a dental chain a mile from my office and they did a “free” consult. His free visit lasted 15 minutes and he got presented with a HUGE treatment plan. The treatment plan is sickening. He got a free initial exam but yet they are going to charge the patient a “consult fee per session” of 156 dollars each time he comes to the office. Then the Corporate Dentist wants to do Advanced Bone Surgery with Guided Tissue Regeneration and Bone Grafting. This is FREAKING NUTS!!!!
Plus, the Clinics fees are WAY higher than my fees. The Clinic fees for SCALING AND ROOT PLANING is 318. Whereas, my office charges 270. However, my hygienist and I examined Lisa’s relative and he only has localized gum tissue infection. There is no way that Lisa’s relative needed the treatment the corporate office proposed.
More price gouging and unbundling of fees as the Corporate office is going to charge 40 dollars to irrigate the gum tissue with Chlorhexidine. At my office this anti-bacterial irrigation is included with the Deep Cleaning fee. Furthermore, the Corporate Clinic is going to charge 118 dollars for putting an antibiotic pellet into the gum tissue. My office charges 34 dollars for this treatment. Lastly, my bone graft fee is 275 and the Clinic is charging 480. The Corporate Treatment plan is full of bull crap up charges and is pathetic.
I was disgusted and sad when I saw how the Corporate Clinic was going to take advantage of Lisa’s relative. Unfortunately, my office sees this all the time. I am passionate about dentistry. I love my profession. However, I am very disappointed with the amount over treatment I see in general. Moreover, everywhere I drive I see these Clinic offices advertising FREE EXAM AND XRAYS. How detailed is the FREE EXAM? How accurate is the free exam? Is the Clinic Doctor going to do the EXACT same treatment he is telling patients they need on his own family members? I guarantee that the treatment I recommend to my patients is the exact same care I am provide for my family.
My new patient exam is an hour. That is an hour of X-rays, photographs, detailed documentation of gum tissue healthy, listening to the patient, understanding the patient’s needs, offering solutions to the patient’s problems, educating the patient, and explaining the treatment.
Lisa’s relative came to see us because he was confused and scared. We did an exam and yes his gum tissue is sick and needs some advanced cleaning. However, our treatment plan is going to cost the patient 797 dollars versus the Corporate treatment plan of 7,028.
The Patient only truly needed $ 797 worth of treatment.
I am very aware on the legacy that my office holds. I came out to Pasadena, Texas in 2009 to take over the practice. Dr. Campbell was 72 years old when he retired. Dr. Campbell performed good, honest dentistry for many many years before he retired. My practice is full of families that stretch several generations. I have so many patients in their 40s, 50s, and 60s and I am the SECOND dentist ever in their life. They have been coming to this office their entire life. These long time patients value our honesty and trust us to provide outstanding dental care.
Free is not free and cheap is cheap for a reason. Cheap can even be more expensive at the corporate dental chains.
Thank you for allowing me and my team to take care of your dental needs.
I saw this patient for a second opinion. She had gone to a Corporation Owned Dental Franchise Clinic in Pearland. A huge misconception is that these Corporate Dental Offices are less expensive because they are “in-network”. That is almost never the case because these offices bill everything possible and often at a higher fee than a private “out of network” dental office.
This patient came to me and I felt she only needed four crowns and one filling. The corporate office was going to do 6 crowns and 3 fillings. What is sad is that the corporate dental office charges MORE for a crown then my office. Furthermore, the corporate office adds a “enhanced cosmetic” fee of 250 dollars to their crown. Lastly, corporate office ALWAYS do a build up on their crowns because insurance will pay for it. Whereas, I do a build up only if it will be of benefit to the patient. Thus, the corporate dental clinic is almost 700 dollars more than my crown fee.
The corporate office also charges more for fluoride varnish. Plus, they have the audacity to charge 75 dollars for Oral Hygiene Instruction. My office charges ZERO for Oral Hygiene Instruction.
This patient had been going to an in-network insurance driven practice. The practice acquires new patients by simply being on an insurance list. If you have a dental insurance policy that forces you to go to an in-network provider, then you have to go to utilize your dental benefits. These in-network dental insurance plans are much cheaper for employers to provide to their employees.
This patient was in for his cleaning and a new dentist he had never seen before told him that two teeth needed crowns. The front desk was very push and wanted him to start the two crowns RIGHT NOW. He declined.
The patient was referred to our office by one of our patients. These were the two teeth in question. They both had a small minor cavity. I was able to conservatively repair the teeth with simple composite white filling.
It is true that in-network offices are less expensive. However, we repeatedly see patients for second opinions that are coming from in-network clinics. Almost always the proposed in-network treatment is not needed.
If you are looking for an office that puts the patient’s best interest first, then we are the office for you.
This busy Mom was a long term patient. She decided to try a dental office closer to her house. She was mortified when her new dental office said she need a lot of work done. Several crowns, fillings and a night guard. Total treatment cost 2984.00 with an out of pocket expense of 1618.95.
She came to me and I did an exam and check up on her. The ONLY thing I thought she needed was a filling on tooth #31 for an out of pocket expense of 88 dollars.
She told me that the instant she walked into the other office is was all about the money. The other office took pictures and told her that her teeth had cracks and her fillings were failing. She was told she was a grinder and needed a night guard. That’s a load of baloney!
The other office is less expensive than my office. The other office is one of those dental offices that has “free exam and X-rays”. Discount offices have to make up lost revenue somewhere. Thus, the over treatment. My office fees allow me to work a slow pace and devote my full attention to the patient in the chair. I don’t double book or overbook. I provide quality work that I am proud of. I will never recommend treatment that I would not do on my own family. The other clinic is a prime example of CHEAPER IS NOT ALWAYS BETTER. Sure the other dental office was cheaper but wanted to do unnecessary work.
Here is what the patient wrote about my office on a Google Review:
Dr. Nugent and his staff are truly remarkable. I went to a different practice in Clear Lake for a regular cleaning and was told that I needed two crowns and 6 fillings immediately (to the tune of $1,600). I was skeptical so I asked Dr. Nugent for a second opinion. I only needed ONE small filling. He is honest and conservative with his treatments. He showed me my x-rays and described his plan very thoroughly and simply. He also cosmetically repaired my two front teeth several years ago that were damaged during a bicycle accident when I was a child. They look BEAUTIFUL now.
Two areas I see where dentists get “creative” is the up sale and unbundling of procedures. This patient was seen in Houston and was very concerned and skeptical about his proposed treatment. The patient even thought about flying back home to California to let his childhood dentist examine him. He expressed his concern to a coworker about his dental plan. The coworker told him that he must drive out to see Dr. Nugent.
Up sale – performing more advanced or unnecessary treatment than is necessary.
Unbundling – charge for services separately rather than as part of a package.
The patient was seen today and in my opinion ONLY needed a tooth #5 filling and need a dental implant to replace tooth #31.
However, the other dentist was going to a much more aggressive and expensive procedure on tooth #5. Plus, do another restoration on tooth #15. The other dentist was going to charge for “re-contouring” and “Mercury Amalgam Removal”. There is no code for “mercury amalgam removal”. This is a made up code. Furthermore, it is written to invoke fear. Even if teeth #5 and #15 needed crowns I do not think a buildup procedure would be necessary. The other dentist was going to charge for a healing stent. In all the dental implants I have placed in my office, I have never had to place a healing stent. Also, I routinely re-contour teeth. It is a billable procedure, but I never charge for it as it take me 10 seconds. I don’t believe in nickeling-and-diming my patients . Lastly, there was no evidence in my examination that this patient need an occlusal guard.
The patient scheduled to come back for a filling on #5 and dental implant #31 at a much less total treatment cost than the Houston Dentist.
My friend in California texted me that he had lost a crown on his lower right and went to his dentist to have it re-cemented back on. My friend is not a consistent dental patient. When he was in the office the dentist said he needed two fillings and a crown on the upper right. My friend told me the news and took a picture of the treatment and texted it to me. I asked if he was in any pain and he said no. I told him to fly in, I’ll do all the work on a Friday because I can make crowns in one visit with my CEREC machine. He comes in on Thursday evening. We go to the office and my assistant takes x-rays. I see nothing to go. I look in the mouth and everything is fine.
The other dentist wanted to do:
- Tooth 2: 3 surface resin filling 372$
- Tooth 3: Crown 1427$
- Tooth 3: Crown buildup 317$
- Tooth 4: 2 surface filling 326$
My recommendation and observations: DO NO TREATMENT
- Tooth 2: Had an existing filling that was perfectly stable and functioning. I saw no reason to remove the filling and make the filling larger like the previous dentist wanted to.
- Tooth 3: This tooth did have two separate large fillings. Both were functioning and there was no need to do the crown at this time. I told my friend that the next time this tooth has a problem the it will need a crown. However, the fillings and tooth maybe be fine another 5 to 20 years. Let’s fix the tooth when there is a problem in the future.
- Tooth 4: This a perfectly healthy tooth that has never had a filling. There was no decay present.
My friend was so grateful he did not do the dentistry in California. He was out the cost of a plane ticket but we had a fun time at the gun range and took my kids to the museum. It is very sad when patients are taken advantage of for purely financial gain. It sickens me that unnecessary work is being performed on patients by greedy dentists. You must have trust in your dentist. That is one reason my practice is so unique. I am the third owner of the practice since 1950. This office performs great honest dentistry and we have patients and their families for life.
Here is another example of someone getting a “free exam and X-ray”. This patient was a friend of a patient and had gone to a dental clinic near her work. The clinic advertised “free exam and x-rays” for a new patients. She was told she had seven cavities and she was concerned. Her friend recommended she come see me for a second opinion. The patient came to me and I did a limited exam and 4 bite-wing x-rays. In my opinion there was NO DECAY present. There was minor staining but I used my cavity detecting laser and verified the stains were not decay.
The problem with FREE is that it is not free. The dental clinic has overhead, pay roll, supplies, rent, government taxes…etc When a clinic sees patients for “free” they are loosing money. That money must be made up somewhere. The clinic tried to extract 1806 dollars with 722.40 coming from insurance and 1083.60 from the patient. The patient did not need the work. The other dental clinic would have been drilling on perfectly healthy teeth in order to charge the patient. The patient would have been much better served by going to an honest dental clinic and paying for a new patient exam.
Free Exam and X-ray Clinics must get warm bodies in the office because they have a HUGE amount of patient turnover. They see as many patients as possible per day and overbook their doctors. These clinics survive on volume of work because they must have lower prices. However, a lot of the work is sub-standard and often not needed.
A Brazillian Jiu Jitsu coach from another school reached out to me and asked me a dental question. He had gone to a corporate clinic dental office for a tooth problem. I told him that is hard diagnosis dental problems via text and told him to come see me.
The corporate office wanted to do a root canal, fillings and two crowns totaling 2,450 dollars. In my opinion the corporate office prices the limited exam and initial x-ray incredibly low to get people in the door. Then they do extra or unnecessary work. Plus, they “upsale” procedures and “unbundle” services in order to charge more. The corporate office wanted to upsale their crowns by making the patient pay more so the crowns would be zirconia. In my office zirconia crowns are one of seval standard crowns. I do several types of crowns and they are all the same fee. I choose what materiel and type of crown will work best for each patient.
I examined the patient and tooth #5 did have a large cavity. I explained the possibility that tooth #5 may need a root canal and crown one day but I felt it was better to do a filling. Furthermore, tooth #4 was perfectly fine.
Our office frequently sees bloated treatment recommendations from insurance driven dental practices. These type of practices cycle through doctors, staff and patients. They sign contracts with insurance companies and become “in-network” with insurance companies guaranteeing a constant influx of patients. On a cursory look corporate offices have lower fees. However, once you look at all the extra charges the price is similar to a private practice fee.
Corporate Office wanted to work on Teeth #4 and #5 at an out of pocket expense of 2,450.
Patient only truly needed work on Tooth #5 totaling 259 dollars.
The most important thing in a doctor/patient relationship is trust. We invite you to see why generations of families trust our office for their dental care.