How Insurance Compliance and Price Fixing Fuel Bad Dentistry

Much of the explosion of chain dentistry is fueled by one key player: the dental insurance industry. Insurance companies, in tandem with DSOs, have created a tightly controlled ecosystem in which profits are maximized—not patient outcomes. This has led to a profession corrupted by the synergistic expansion and collusion between insurance companies and corporate chains. Dentists no longer have control over their materials, their labs, or even their schedules. Quality has taken a backseat to compliance, and the patient is the one who suffers. Day-to-day operations—including supply orders, staffing, and even which specialists you’re referred to—are typically decided by franchise managers or non-dentist executives.

Network market control:

Insurance companies set artificially low UCR (Usual, Customary, and Reasonable) fees, particularly in areas with heavy DSO contracted network presence. This strategic suppression of reimbursement rates discourages independent providers and rewards high-volume chains. It’s price fixing in all but name.

• According to a 2021 report by the American Dental Association Health Policy Institute, insurance reimbursement rates have declined by an average of 5% over the past decade in markets dominated by DSOs.

Dentist employed by insurance companies to fight other dentist claims:

To make matters worse, insurance companies employ their own dentists—not to treat patients, but to review and deny claims. Even the most legitimate, well-documented treatments can be downgraded or denied by reviewers who have never seen the patient. This system is designed not to reimburse, but to delay and discourage treatment, pushing patients back into the contracted network of "preferred providers" who accept low fees in exchange for volume.

• The National Association of Dental Plans (NADP) highlights that over 60% of dental plans restrict patient choice by limiting in-network providers.

Quality Dentistry Takes Time — But DSO/ franchise Quotas and High Volume Don’t Mix:

Good dentistry takes time, skill, and attention to detail. Unfortunately, under the high quotas and volume demands of most dental franchises and DSOs, these two essentials are often at odds.

Day-to-day operations—including supply orders, staffing, and even which specialists you’re referred to—are typically decided by franchise managers or non-dentist executives focused tailored to each patient’s unique needs.

There comes a point where the “product” simply can’t be made within the cost constraints which we are rapidly approaching with this mode of opertaion.  It’s like trying to manufacture a quality car on a motorcycle budget.

So what is the “motorcycle market” for dentistry? It’s a one-size-fits-all approach, often driven by insurance agreements, referral kickbacks, and profit margins benefiting the DSO rather than patient well-being.

• The National Association of Dental Plans (NADP) highlights that over 60% of dental plans restrict patient choice by limiting in-network providers.

Call to Action:
Don’t let insurance -corporate DSO limitations dictate your dental care. This is why independent dentists who control their materials, labs, and treatment decisions provide care that is more thorough, tailored, and trustworthy.

Contact us to learn how we offer transparent  quality care without compromise.