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Old 09-21-2013, 09:12 PM   #16
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It's not personal - it's about providing safe and effective care and billing for such in certain circumstances, such as working on the teeth of a screaming child or adult. Whether you noticed it or not, your dentist and his or her staff were assessing your child and intervening in order to deal with the problem at hand. And it sounds like they did a great job if they fixed the tooth in just 5 minutes!

No matter what pediatric dentist you see, they will use - and you will be billed for - behavior management, if it's an issue.

This is accepted standard from the ADA and AAPD.

http://www.aapd.org/media/Policies_G...BehavGuide.pdf

http://www.greenepediatricdentistry....cies/index.php

In the hospital we use a "scoring system" for patients' needs, and we also get credit if the patient, or a family member, requires specific extra time from the nurse because it does take more resources to do so, and those resources always have to be accounted for. That is the way health care is today.

Your dentist did nothing wrong here. He is entitled to be compensated for the specialized care he provided. He and his staff have required specialized training in behavior techniques, and may even have yearly testing on it for accreditation purposes, etc.
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Old 09-21-2013, 09:16 PM   #17
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They aren't common in my area and I have been in the dental field for 25 + years! Sedation is a covered expense and the reason why we refer out some of our little ones. Since this dentist is "in" network, you may not have to pay for it. They agree to accept a certain payment and can't charge you addt fees in some cases. So check with them and see. Then change dentists, since he didn't use sedation, you can hold her just as well in a general dentist's office if he's the only pedo in town. Monday I will be looking in the ADA code book for that one. We spent 2 hours doing a filling on an 8 year old a few weeks ago. He came in for the second one last week and was totally different, his fear of the unknown was known! 15 months is so young hopefully she won't have bad memories of the visit.
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Old 09-21-2013, 10:11 PM   #18
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I had to argue a charge with my son's pediatrician. We went in for a sport physical and I brought with me his prescriptions given by his dermatologist so that they could put them in their computer. I figured his primary doctor should know what he was taking in case of drug interactions, etc. So I get bill, which I shouldn't have because we get one well check per year, for a charge for a diagnosis of acne! I went to the office and talked to the person in charge of billing and told her we already paid a dermatologist to diagnose his acne and that I only mentioned it so that they would know about the medicine. She removed the charge, but jeez. They will bill for everything they can.
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Old 09-21-2013, 10:27 PM   #19
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I think that $110 is more than fair - I certainly wouldn't be complaining.
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Old 09-21-2013, 10:45 PM   #20
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Quote:
Originally Posted by tvguy View Post

BEHAVIOR MANAGEMENT: In our practice we occasionally find it necessary to invest beyond standard appointment time in the Management of certain patients. This may be due to medical, emotional, or behavioral issues. We are more than willing to provide this service; however there is a charge of an additional behavior management fee on “kid time.” This fee is related to the cost of committing the time and staff to achieve the optimum outcome for more sensitive patients.
The procedure took 5 minutes. That's hardly covered under that quote.


OP, in my opinion pediatric dentists are bananas to a large extent. Finding a good one is like finding a needle in a haystack, and they are going to be the ones with the LONG waiting lists.

DS had tooth problems from early on; possibly because of facial trauma at 6 months old or maybe because of his dad's family's tooth problems (or a combo), and it took us a YEAR to find a decent, sane dentist. All the while two of his teeth were rotting away.

First one wasn't a pediatric dentist but talked a good game; we had 3 mini-visits to her (awesome idea, if she weren't over an hour away) to get him used to her, the office, and the instruments. But at the end she wasn't sure of dosing for doing the work, and wouldn't do it.

The second guy, a pediatric dentist, had a GORGEOUS office, I mean deluxe. Went in, and he had DS diagnosed with bottle mouth without ever looking into his mouth. It was amazing, how he did that, despite the fact that DS had never had a bottle or juice. What he WAS doing was looking at DH and me, and making nasty assumptions that because WE were heavy, we were obviously feeding him absolute junk. He then judged me for leaving the room when it came time for the exam, and scoffed when I explained that we learned (in this 3 mini visits) that my ONE year old acted very babylike (what a surprise) when he was with me, but got all "I'm a big brave boy" when he was with DH. I was trying to make the guy's work easier and I got judged for it. He then diagnosed a whole bunch of things and said we'd need to coordinate with medical insurance to have a bucketload of work done, under General, in the *office*. Yeah, NO. General will be done in the hospital, and by the way, you're talking about taking out FOUR teeth from the front of his mouth and you're saying he won't have speech problems because of it? Oh ha ha ha. No wonder your office is so gorgeous from what you're charging.

Got a referral to another pediatric dentist from mothering.com's forums (and also from a yahoogroup, veryyoungkidsteeth), and his office was wonderful. Went in for a quick visit. Went back to have a big filling done (where the other guy was just going to take out those teeth) and he used NO medication because it wasn't needed. His behaviour management was playing Finding Nemo in the TVs in the ceiling. Went back to have the two teeth removed; used a blip of lidocaine and had both out inside of 5 minutes. Their office is awesome. They aren't perfect, but it's just administration stuff (they think that HIPAA applies to patients' parents instead of them, and say "no cell phones" so that they can have conversations with parents in the waiting room in front of other parents...no...this was a problem for us because DH would take DS to appts but I'm the healthcare decision-maker and he HAD TO call me sometimes.)

Once you find a good one the other ones just look ridiculous.
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Old 09-21-2013, 10:47 PM   #21
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My daughter is 2. She has a pediatric dentist. She has had 3 check ups cleanings. Each time she bites him and usually cries too. We have never had a behavior charge. Between him and the hygienist they bill $181, but that's what they always bill. We just went last week. Dentist was happy she was finally old enough to respond to verbal commands to stop biting. She can also be bribed with stickers to stop crying but it only lasts a minute, maybe next time.
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Old 09-21-2013, 11:13 PM   #22
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Quote:
Originally Posted by DvF Diva View Post
How much does insurance cover? Does it sound like they're tacking on extra fees to try to wring more out of your insurance company?
It was supposed to be $50 for the visit (I verified with ins before the appointment). They billed my insurance co and they won't pay the $35. There was a bunch of other fees that made the bill $110 but the only one that stuck out was the behavioral fee!
Quote:
Originally Posted by IndianaPrincess View Post
Aren't you suppose to approve things that are outside of insurance's coverage? That is wrong a many levels.
If I was told there was a $35 charge for whatever it is that bill is for, I would have left!

Quote:
Originally Posted by MinnieForMe View Post

How did they think a 15 month old would react? Open her mouth and say "please" and "thank you"? She's just a baby and her behavior was normal!


Quote:
Originally Posted by tvguy View Post
I guess I could see being upset at that being itemized on the bill.
But stepping back, you got a dentist to do something that entire procedure for only $110? Not sure you could have a dentist do anything for just $50.

.
To clarify, $110 is what the insurance co would not cover. They already billed the ins co. and they paid all but $110.
Quote:
Originally Posted by tvguy View Post
Okay, you peeked my curiosity. So I googled it.

Behavior management fees are common, and accepted in dentistry. Government programs that pay for children's allow a charge for it. The ADA lists it as something a normal dentist's office would charge.

Many dentists with websites even got a step further and disclose it on their websites:

http://www.magicsmilesdds.com/office.../fees-policies

BEHAVIOR MANAGEMENT: In our practice we occasionally find it necessary to invest beyond standard appointment time in the Management of certain patients. This may be due to medical, emotional, or behavioral issues. We are more than willing to provide this service; however there is a charge of an additional behavior management fee on “kid time.” This fee is related to the cost of committing the time and staff to achieve the optimum outcome for more sensitive patients.
That's the thing - what extra services did they provide? Between putting on the bonding and getting information, he was in the room for 10 minutes.

Quote:
Originally Posted by Pea-n-Me View Post
It's not personal - it's about providing safe and effective care and billing for such in certain circumstances, such as working on the teeth of a screaming child or adult. Whether you noticed it or not, your dentist and his or her staff were assessing your child and intervening in order to deal with the problem at hand. And it sounds like they did a great job if they fixed the tooth in just 5 minutes!

No matter what pediatric dentist you see, they will use - and you will be billed for - behavior management, if it's an issue.

This is accepted standard from the ADA and AAPD.

http://www.aapd.org/media/Policies_G...BehavGuide.pdf

http://www.greenepediatricdentistry....cies/index.php

In the hospital we use a "scoring system" for patients' needs, and we also get credit if the patient, or a family member, requires specific extra time from the nurse because it does take more resources to do so, and those resources always have to be accounted for. That is the way health care is today.

Your dentist did nothing wrong here. He is entitled to be compensated for the specialized care he provided. He and his staff have required specialized training in behavior techniques, and may even have yearly testing on it for accreditation purposes, etc.
He did a great job because I had the death grip on my daughter and didn't let her move an inch.
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Old 09-21-2013, 11:15 PM   #23
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Quote:
Originally Posted by ThisIsTheYear View Post
My 15 month old daughter broke her front tooth and the dentist needed to put a bonding on it because it was sharp and also the tooth could have been sensitive. He instructs me how to hold her, which I did very well. They put the clamp in her mouth and for the next 5 minutes he puts on the bonding. She was screaming the entire time, they close the door and the assistant kept saying, "It's okay, shhh". So today I get a bill for $110 (it should have been $50 but that's another rant) and $35 of that is for "Behavior Management"! Seriously!? And while I'm on a tangent - why do bills always arrive on Saturday so I can stew about them all weekend!?

P.S. He is a "Pediatric Dentist"!
Since YOU were the one managing your daughter's behavior by holding her down, then YOU SHOULD REFUSE TO PAY THAT! Saying shh, it's ok isn't doing anything at all. If they don't eat that charge, I'd refuse to pay it and find another dentist. I'd pay for the procedure itself but not for behavior management. You were doing everything except the actual five minute dental procedure.
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Old 09-21-2013, 11:16 PM   #24
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Quote:
Originally Posted by kymom99 View Post
I had to argue a charge with my son's pediatrician. We went in for a sport physical and I brought with me his prescriptions given by his dermatologist so that they could put them in their computer. I figured his primary doctor should know what he was taking in case of drug interactions, etc. So I get bill, which I shouldn't have because we get one well check per year, for a charge for a diagnosis of acne! I went to the office and talked to the person in charge of billing and told her we already paid a dermatologist to diagnose his acne and that I only mentioned it so that they would know about the medicine. She removed the charge, but jeez. They will bill for everything they can.
That's crazy!
Our pedi's office charges an additional fee if the appointment is after 5 or on Saturday and my ins won't cover that. I have to be careful to make my appointments at 4:45!
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Old 09-21-2013, 11:23 PM   #25
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Quote:
Originally Posted by tvguy View Post

Actually, having a second to think about it, I can see a pediatric dentist, who deals with difficult patients, would have such a charge.
Just curious, do you think a Pediatrician should charge a behavioral management fee? I have to hold DD down when she gets her shots.
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Old 09-21-2013, 11:36 PM   #26
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Quote:
Originally Posted by bumbershoot View Post
The procedure took 5 minutes. That's hardly covered under that quote.


OP, in my opinion pediatric dentists are bananas to a large extent. Finding a good one is like finding a needle in a haystack, and they are going to be the ones with the LONG waiting lists.

DS had tooth problems from early on; possibly because of facial trauma at 6 months old or maybe because of his dad's family's tooth problems (or a combo), and it took us a YEAR to find a decent, sane dentist. All the while two of his teeth were rotting away.

First one wasn't a pediatric dentist but talked a good game; we had 3 mini-visits to her (awesome idea, if she weren't over an hour away) to get him used to her, the office, and the instruments. But at the end she wasn't sure of dosing for doing the work, and wouldn't do it.

The second guy, a pediatric dentist, had a GORGEOUS office, I mean deluxe. Went in, and he had DS diagnosed with bottle mouth without ever looking into his mouth. It was amazing, how he did that, despite the fact that DS had never had a bottle or juice. What he WAS doing was looking at DH and me, and making nasty assumptions that because WE were heavy, we were obviously feeding him absolute junk. He then judged me for leaving the room when it came time for the exam, and scoffed when I explained that we learned (in this 3 mini visits) that my ONE year old acted very babylike (what a surprise) when he was with me, but got all "I'm a big brave boy" when he was with DH. I was trying to make the guy's work easier and I got judged for it. He then diagnosed a whole bunch of things and said we'd need to coordinate with medical insurance to have a bucketload of work done, under General, in the *office*. Yeah, NO. General will be done in the hospital, and by the way, you're talking about taking out FOUR teeth from the front of his mouth and you're saying he won't have speech problems because of it? Oh ha ha ha. No wonder your office is so gorgeous from what you're charging.

Got a referral to another pediatric dentist from mothering.com's forums (and also from a yahoogroup, veryyoungkidsteeth), and his office was wonderful. Went in for a quick visit. Went back to have a big filling done (where the other guy was just going to take out those teeth) and he used NO medication because it wasn't needed. His behaviour management was playing Finding Nemo in the TVs in the ceiling. Went back to have the two teeth removed; used a blip of lidocaine and had both out inside of 5 minutes. Their office is awesome. They aren't perfect, but it's just administration stuff (they think that HIPAA applies to patients' parents instead of them, and say "no cell phones" so that they can have conversations with parents in the waiting room in front of other parents...no...this was a problem for us because DH would take DS to appts but I'm the healthcare decision-maker and he HAD TO call me sometimes.)

Once you find a good one the other ones just look ridiculous.
We had a great one but he doesn't take our insurance. (He had TVs in the room too! lol). Now I'm really considering paying out of pocket!
I'm glad you found a great one!
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Old 09-21-2013, 11:39 PM   #27
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Quote:
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The procedure took 5 minutes. That's hardly covered under that quote.
I agree. I could understand if this was a ten year throwing a fit and causing the procedure to be lengthened due to bad behavior, but I don't see how a procedure on a child that young could have been expected to go any faster or more smoothly.
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Old 09-21-2013, 11:40 PM   #28
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We had a great one but he doesn't take our insurance. (He had TVs in the room too! lol). Now I'm really considering paying out of pocket!
I'm glad you found a great one!
We don't have dental insurance, and our dentist does adjust his rates for cash customers. Have you asked them about it?
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Old 09-21-2013, 11:57 PM   #29
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Originally Posted by horseshowmom View Post
We don't have dental insurance, and our dentist does adjust his rates for cash customers. Have you asked them about it?
No I haven't, but I will! Thanks!
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Old 09-22-2013, 12:27 AM   #30
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My kids don't go to a pediatric dentist. My youngest went to one for a couple of visits and I hated it there. We found a really good dentist and they have all done great with his office. They have tvs in the rooms and a huge fish tank with the bright fish. The dentist will talk to the kids and treat them with respect. They do have the parents wait in the waiting room as it seems to work better for the kids. I'm not sure the youngest age he sees though.

OP - talk to the dentist and see if they will do whatever needs done to accept your insurance. Some are very understanding and will do what they can to keep good patients
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