I'm so angry - dentist charged for "behavior management"!

[luvmy3]

He didn't use any of that. Just a clamp to keep her mouth open and 'stuff' he attached to the tooth.

I wonder if it is for the use of the clamp?

 

[NYCDiane]

Our family dentist had a unique form of behavior management. With kids old enough to go into his office alone, he slapped them if they acted out. Only heard about this a couple of years ago. Otherwise, he was a great dentist, did fine work.

If a dentist ever slapped my daughter, he'd find himself in handcuffs!!! Are you kidding me???? Unique? He'd absolutely find himself on the wrong side of a lawsuit for assault.

 

[buckirj1]

Behavior Management is a valid charge. I don't see what all the fuss is about, except I suspect the name is what sets off the mommy-types.

 

[hereyago]

Our family dentist had a unique form of behavior management. With kids old enough to go into his office alone, he slapped them if they acted out. Only heard about this a couple of years ago. Otherwise, he was a great dentist, did fine work.

My first dentist in the early 70's here in VA attempted to slap me, I yelled don't hit me and my df came in, because he heard us both yelling.. He got a black eye,hopefully after that he learned his lesson.

 

[Granny square]

Behavior Management is a valid charge. I don't see what all the fuss is about, except I suspect the name is what sets off the mommy-types.

I think that it is the fact that the parent didn't know about it in advance. Unethical.

The ofc staff didn't do any behavior management either. Except class the doors...

 

[ariel71]

Another thread with many villagers responding with tar and feathers ("reporting to the BBB", "posting on facebook", "unethical") to a very one-sided post. OP's depiction of events may indeed be completely factual, but the truth is we don't have an objective story and IMO those statements are reckless and unwarranted at this point.

- OP just got the bill yesterday and has not discussed it with the practice.
- Humans aren't very good at time perception. Unless OP looked at her watch, "5 minutes" aren't necessarily 5 minutes (OP may have looked at her watch; we don't know). What was initially 5 minutes for the dentist then became 10 minutes in a later post when adding in "getting information". Unless we have the complete picture of the entire appointment compared to what the average appointment for this procedure would be, no one can say that the fee is unreasonable.
- The fee is probably based on additional time for all of the staff and not just the dentist himself. Did they have to keep the room occupied for an extra 10 minutes after the procedure before OP's daughter calmed down? Just saying there could be other factors that OP hasn't mentioned.
- The fee could have been outlined in the initial paperwork that new patients fill out (similar to missed appointment fees). Many people just glance over those forms and don't read them carefully.

I get that OP is angry and perhaps justifiably so. I'm not siding against OP. I think that ideally any practice should disclose possible fees like this with new patients (before the initial appointment). But similar to the "why is escalation the immediate response" thread, I just don't understand any response at this point other than to discuss it with the practice on Monday.

 

[tvguy]

Just because a provider *CAN* bill for it, doesn't mean that they *SHOULD*. If there is a CPT code associated with the fee, there is a specific definition of what service it covers, not "almost" describes it, not "its seems like it produces a fair amount".....drives me crazy how many providers with "code stuff" into a CPT code to maximize their reimbursement. Not saying this is what the dentist did, but it is not unheard of and if the OP has a concern she should seek more information.

OP- you would be within your rights inquire as to what precise service the dentist was attributing to "behavior management" and then make your decision as to whether or not you believe it was warranted and then decide whether to continue with the practice.

I agree, no reason OP should not question the charge.

It is listed as a customary charge, so to me the "Can" and "Should" argument doesn't apply.

 

[Pea-n-Me]

I can't believe people are still miffed about this.

Back on page 2 of this thread, I posted the actual policy from the American Academy of Pediatric Dentistry entitled Guideline on Behavior Guidance for the Pediatric Dental Patient.

I'll post it again for those who missed it. http://www.aapd.org/media/Policies_Guidelines/G_BehavGuide.pdf

This policy was first adopted in 1990, and has been revised several times since then, most recently in 2011.

Originating Committee
Clinical Affairs Committee – Behavior Management Subcommittee
Review Council
Council on Clinical Affairs
Adopted
1990
Revised
1991, 1996, 2000, 2005, 2006, 2008, 2011

I'm not sure how much clearer it can be that this is accepted practice.

Dental professionals are entitled to compensation from services they provide, like it or not.

I guess where we seem to be having a disconnect is, what exactly is behavioral management?

The answers are containted in the article but things like positive reinforcement, voice control, and yes, even Mom being in the treatment room with the patient are all considered behavior management techniques, among many others - even when and if patients don't realize it.

OP, you want to maintain the staff did "nothing", but if your child successfully had her tooth fixed, then the techniques they used did work. I'm sorry you can't be more appreciative of what it takes to do a good job under circumstances such as these. It is what they do routinely, so they probably make it look so easy that you and I might easily ovelook things. It is absolutely stressful as a parent going through this, too!

I think the suggestion of calling the office was a good one, but the person you talk to should be the dentist, as obviously there are a lot of people who don't understand how these charges work, even some who work in dental offices.

By the way, I'm not a fan myself. I left two pediatric dental practices because I didn't like them for various reasons, and our family has been happy at a general dentist's office for many years now. So I'm not trying to defend anyone unnecessarily. I am just acutely aware of how the general public doesn't often understand the behind-the-scenes of healthcare, and I hate to see anyone getting completely ripped based on misinformation. Hopefully this may clear up a little bit of the misconception.

I am truly happy your daughter was able to have her tooth fixed in 5 minutes. I have horrible memories of being held down and gassed when I was a child, and waking up crying and in pain, bleeding, scared, angry, etc., so I'm appreciative of how things have changed in dental medicine for the better. I've also worked in a pediatric ER and you should see what it's like trying to help a plastic surgeon apply stitches to a face and keep a hysterical child still for that, sometimes for a half an hour or more; or doing a lumbar puncture on a newborn infant - or 200 lb. frightened teenager who won't stay still! In other words, I think you should take a step back and look at how this really went down, what it took for your dentist and his staff to be able to get to a place where they can do such a thing, and then discuss it with your dentist. It wouldn't surprise me if he removes the charges to keep you happy, but it won't be because they shouldn't be there. Perhaps some dentists don't label them as such (no wonder why) but instead roll them into other charges and increased fees, etc.

American Academy of Pediatric Dentistry website http://www.aapd.org/policies/

 

[DOREEN1779]

I can see how this is upsetting but I would address your billing concern with the dental office tomorrow and let them explain it. We use a pediatric dentist for all three of my children since their first tooth came in. My middle child is autistic and is not the greatest patient. I am very familiar with the death grip. When I schedule an appointment, I remind the receptionist of his diagnosis and they book extra time. However, I have never been charged for that extra time. Honestly, if I was, they would be justified. The dentist told me that they would rather try to saturate the behavior over time then simply sedate. I know this is not your situation but they may bill the insurance company because it is an approved procedure from their contract and the insurance company will pay it simply because your child is under a certain age that justifies the charge. Honestly, for NJ, that fee sounds really reasonable for the work your daughter had done. Anyway, I hope it all works out for you.

 

[Pea-n-Me]

I can see how this is upsetting but I would address your billing concern with the dental office tomorrow and let them explain it. We use a pediatric dentist for all three of my children since their first tooth came in. My middle child is autistic and is not the greatest patient. I am very familiar with the death grip. When I schedule an appointment, I remind the receptionist of his diagnosis and they book extra time. However, I have never been charged for that extra time. Honestly, if I was, they would be justified. The dentist told me that they would rather try to saturate the behavior over time then simply sedate. I know this is not your situation but they may bill the insurance company because it is an approved procedure from their contract and the insurance company will pay it simply because your child is under a certain age that justifies the charge. Honestly, for NJ, that fee sounds really reasonable for the work your daughter had done. Anyway, I hope it all works out for you.

#1 bolded: And this would be considered a behavior management treatment decision!

#2 I was thinking the same thing. Charges are sometimes astronomical!

I'm so glad you found a dentist that works well with your son.

 

[Granny square]

Interesting information. Seems pediatric dentists could charge all kids when things like voice modulation are billable.

Lol, I could make big bucks if I charge behavioral for such ridiculous things.

 

[Pea-n-Me]

Interesting information. Seems pediatric dentists could charge all kids when things like voice modulation are billable.

Lol, I could make big bucks if I charge behavioral for such ridiculous things.

Why do you suppose pediatrics is a specialty?

 

[Granny square]

Why do you suppose pediatrics is a specialty?

I think I have a lovely general dentist who speaks kindly to little ones, offers stickers as rewards, and who knows kids sometimes need parents. I think that someone who specializes in kids should be no different.

I work predominately with kids and never thought to charge for not yelling at them, having a surprise box, and letting mom or dad stay with them.

 

[Pea-n-Me]

I think I have a lovely general dentist who speaks kindly to little ones, offers stickers as rewards, and who knows kids sometimes need parents. I think that someone who specializes in kids should be no different.

Would your general dentist work on the tooth of a screaming, squirming child?

Mine refers out to peds.

When a specialty requires something - such as something like this, since it is policy - then a lot has to go into getting there. Training, certifications, re-training, recertifications, updating, inspections for accreditations, etc. Those all take time and money. Naturally, there will be a charge for these services, as there should be, as this is what you're going there for.

It may seem ridiculous to you, but apparently the AAPD disagrees.

 

[DOREEN1779]

#1 bolded: And this would be considered a behavior management treatment decision!

#2 I was thinking the same thing. Charges are sometimes astronomical!

I'm so glad you found a dentist that works well with your son.

Me too! We have been very fortunate. I even found a hairdresser who opens up the store early to make my son more comfortable and a pediatrician who will see us off hours and on Sunday to relieve his anxiety or maybe my anxiety....

 

[luvmy3]

OP, please do update after you talk to your dentist's office. I am assuming that it is because of the age of your child and the use of the clamp, but am really curious as to what exactly the charge is for.
Hope you get it all straightened out

 

[delilah]

When my son was young, he had "behavior management" problems that I think, in retrospect, were more related to the specific dental hygienist than to my son. Never was charged "extra" except they sent him to a pediatric dentist to do his fillings and such, because they just didn't want to deal with it. The pediatric dentist never had any concerns with his behavior. Only problem was that the pediatric dentist they referred us to wasn't open on my day off (I am a physician myself), so I had to find one on my own that was. And, then, they had issues with scheduling on school holidays as opposed to taking him out of school (which I won't do for routine appointments for routine things, like routine dental work; emergencies or surgery is a different case). But, we got it done.

But, I figured out over time that the hygienist (and not the dentist) was a pistol. One time, I thought I made an appointment for a cleaning for my son at 3:40, and the appointment actually was at 3:20, and I arrived at 3:30. There was nobody else in the waiting room at the time, so, I signed in, and the receptionist said we could wait. We waited for the hygienist to take us back until after 5pm. I don't remember the specifics of the situation, but, I think my son had TaeKwonDo at 6 pm. The amazing thing about the situation was that only one patient came out of the treatment area the entire time we were waiting. I think they were having an office party back there or something, because it was around Christmas time.

Then, the straw that broke my back was when I needed to reschedule his cleaning, once again in December, because I had inadvertently scheduled an orthodontist appointment too close to the dental cleaning appointment. When I tried to reschedule, they tried to give me an appontment right at 3 pm. My son's school is a 5 minute drive from the dental office, but, dismissal is at three, and because of the car line, I didn't think I would be able to get him a couple minutes early (people used to start waiting in the car line at 2:30). So, I asked if he could be seen if he were 5 minutes late, and the answer was "no". Then I asked if there were any later appointments, and they told me there were none until February the next year. So, I changed dental office, but, as it turned out, not dentists. Early in the fall, the dentist we had usually seen moved out of that office, and so, we now see her in her new office.

 

[gottaluvPluto]

Would your general dentist work on the tooth of a screaming, squirming child?

Mine refers out to peds.

When a specialty requires something - such as something like this, since it is policy - then a lot has to go into getting there. Training, certifications, re-training, recertifications, updating, inspections for accreditations, etc. Those all take time and money. Naturally, there will be a charge for these services, as there should be, as this is what you're going there for.

It may seem ridiculous to you, but apparently the AAPD disagrees.

I think the dentist deserves the fee. Working on a screaming child sounds difficult. If I were the OP, I would just pay it and start teaching my child about the dentist.

I started preparing my kids about the dentist when they were babies. WE started out with reading books and then I took them with me to the dentist. My kids were always very well behaved at the dentist. In fact, my kids would cry if I told them I canceled their dentist appt.

 

[laceyinwonderland]

Sheesh this is crazy! I work in the health care industry and deal with difficult people every day. I don't get paid extra to do it because its my J.O.B. to do so! At my DD's last visit, the xray piece made her gag and throw up. If we saw the same dentist as the OP we probably would have been charged something ridiculous for that too! OP best wishes! Hope you get it taken care of!

 

[Shelleybeans]

I can't believe people are still miffed about this.

Looking up theory and law is entirely different than what is "usual, customary, and reasonable" and/or common practice.

Would your general dentist work on the tooth of a screaming, squirming child?

Mine refers out to peds.

When a specialty requires something - such as something like this, since it is policy - then a lot has to go into getting there. Training, certifications, re-training, recertifications, updating, inspections for accreditations, etc. Those all take time and money. Naturally, there will be a charge for these services, as there should be, as this is what you're going there for.

It may seem ridiculous to you, but apparently the AAPD disagrees.

It does seem ridiculous to me. Training for what, verbal redirection? I could see using this charge for nitrous oxide, pre-medicating with valium (requiring monitoring of vital signs), or some sort of restraint (requiring frequent assessment of circulatory status and pressure points). But verbal redirection while MOM holds the hands down? That requires no special training of a dentist or a dental assistant. They didn't pull out any special pediatric dentistry "tricks of the trade" from what I've heard from the OP. Just because it is justifiable under the AAPD's definition doesn't mean it is ethical, especially not without a quote beforehand. Patient care requires verbal redirection often. Even in my line of work in the ICU. And we don't bill for that there either.