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Old 09-26-2013, 12:35 PM   #151
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Originally Posted by luvmy3 View Post
Oops, I totally overlooked that in the OP

I still think the OP has grounds to fight the charge though since according to her the assistant only sshhhed her baby, they didn't hold or restrain her herself.
I believe that the sssh and the mom being there and holding were the culmination of the treatment decision, not the entire thing. What they did allowed the treatment to happen successfully.


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Pea, I won't shoot you. I actually agree with that article.
We see the effect of certain parenting styles everywhere, look at all the threads here complaining about them Its no surprise that people like dentists would have to deal with it, and charge accordingly for it.
Sometimes I wish I could bill a parent for the effect their parenting style has on me
(I am not at all saying this was the case for the OP)
I was actually a little surprised to come across such literature. It probably helps explain why I left two pediatric dental practices myself.
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Old 09-26-2013, 12:38 PM   #152
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Originally Posted by Pea-n-Me View Post
I believe I saw somewhere that Behavior Management charges are not covered by insurance due to the high number of fraudulent claims they've had historically. (Note this is not to say that all such charges are fraudulent.)
So PC, informative, and intelligent!
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Old 09-26-2013, 12:48 PM   #153
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Just because a kid screams is not in my book grounds for an extra charge. Sorry, that's just part of the business. It requires no extra time or significant effort on their part to just let the kid scream away, so an extra charge is not valid if that's all they did on their part. Are there articles about how to handle this? Sure, and I hope a dentist reads them or is otherwise trained in how to handle it. But if there is no extra labor or time taken, it does not deserve an extra charge.

BUT if the dentist did in fact spend extra time, either working with the patient or explaining things to the mother in more detail than usual, or used an extra assistant, then I would consider the charge valid.

Only the dentist will be able to explain and justify this one. The fact that the dentist "often adds it" isn't an explaination I would find acceptable. Wanting a specific explanation for why it was added in this case is a reasonable request.

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Old 09-26-2013, 01:40 PM   #154
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So PC, informative, and intelligent!
Say what? Please explain what you mean.
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Old 09-26-2013, 04:19 PM   #155
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Originally Posted by mom2my3kids View Post
The insurance may or may not pay it, I got charged for both kids for floride because my insurance only covers it once a year and my dentist office for some reason applies it twice a year..
This happened to us. When I called and asked about why it was on our bill, the office apologized and removed the charge. Part of accepting insurance is accepting what insurance pays and not passing the extra to the patient. If it is outside of what your insurance covers, then you have to agree to it beforehand or they are out of luck and have to write it off.

OP - I hope you press this!
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Old 09-26-2013, 07:06 PM   #156
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Originally Posted by Pea-n-Me View Post
I believe I saw somewhere that Behavior Management charges are not covered by insurance due to the high number of fraudulent claims they've had historically. (Note this is not to say that all such charges are fraudulent.)
If you Google it, I think you will it hard to find an insurance company that does not cover Behavior Management fees. Federal insurance programs, which tend to exclude a lot of services, cover it.
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Old 09-26-2013, 07:35 PM   #157
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This happened to us. When I called and asked about why it was on our bill, the office apologized and removed the charge. Part of accepting insurance is accepting what insurance pays and not passing the extra to the patient. If it is outside of what your insurance covers, then you have to agree to it beforehand or they are out of luck and have to write it off.

OP - I hope you press this!
I said I wouldn't post again, but I feel the need to correct this because it is patently false. If something is not covered by insurance, then it is the patient's responsibility. If a patient wants veneers to make their teeth look better, no insurance company in the world will cover it, but you bet that the patient will be paying for it. If the insurance company decides that the patient could have had a filling instead of a crown (regardless of the fact that the patient really needed a crown), then the patient will be paying for it. An insurance company trying to dictate what a dentist can and cannot do outside the scope of the policy has been found illegal in multiple states.

Insurance companies are in it for their own profit and the patients ideal care is not their number one priority. The only thing the insurance company does is force the dentist to set his rates according to their fee schedule. A dentist can't charge the patient more than the insurance company's set fee and then collect the remainder from the patient.
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Old 09-26-2013, 07:44 PM   #158
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Originally Posted by kellylfitz View Post
The only thing the insurance company does is force the dentist to set his rates according to their fee schedule. A dentist can't charge the patient more than the insurance company's set fee and then collect the remainder from the patient.
They can here in Canada.

Our dentist routinely rounds up on all procedures. If the Dental Fee Guide says it can be billed up to $97.25 for that particular procedure, his charge will be $100. And we are out of pocket for the difference, as our insurance coverage will not pay beyond what is set out in the fee guide.
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Old 09-26-2013, 07:50 PM   #159
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They can here in Canada.

Our dentist routinely rounds up on all procedures. If the Dental Fee Guide says it can be billed up to $97.25 for that particular procedure, his charge will be $100. And we are out of pocket for the difference, as our insurance coverage will not pay beyond what is set out in the fee guide.
I cannot speak for Canada as I have not practiced there, but it is very illegal in the United States and any dentist doing it can be criminally prosecuted for insurance fraud. That is not to say that some dentists don't do it.
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Old 09-26-2013, 08:43 PM   #160
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kellylfitz, I think upthread you said you were a dentist. My children and I go to my dentist (and they always have). She is wonderful!! And it sounds like you're very conscientious, and a great dentist.

Our last appt was last month. Our younger dd who is 8 and has autism had 2 cavities. I had one under an existing cavity. Our dentist was able to fill hers in 15 minutes, max. No lidocaine shots, thank goodness. The only reason I mention dd has autism is that this dentist has spent 7 yrs building a relationship with dd. I think that is so crucial, because you see the payoff when treatment is needed, like then. No tears, no drama.

On the other hand, my cavity, which was my first in 30 yrs, took an hour from lidocaine shots, to finishing drying of the filling. It was a yucky process, drilling through the old filling, and making sure she drilled out all the new cavity. This is where I have to really express my thanks to you guys. I got billed $135 for an hour's worth of work. I can't imagine a medical doctor spending an hour with me, and only billing $135. I trust her implicitly, because she always puts our health first, and $$ second. Never tries to sell me on the whitening procedures LOL, thank goodness!!

You sound like my kind of dentist!!
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Old 09-26-2013, 09:00 PM   #161
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kellylfitz, I think upthread you said you were a dentist. My children and I go to my dentist (and they always have). She is wonderful!! And it sounds like you're very conscientious, and a great dentist.

Our last appt was last month. Our younger dd who is 8 and has autism had 2 cavities. I had one under an existing cavity. Our dentist was able to fill hers in 15 minutes, max. No lidocaine shots, thank goodness. The only reason I mention dd has autism is that this dentist has spent 7 yrs building a relationship with dd. I think that is so crucial, because you see the payoff when treatment is needed, like then. No tears, no drama.

On the other hand, my cavity, which was my first in 30 yrs, took an hour from lidocaine shots, to finishing drying of the filling. It was a yucky process, drilling through the old filling, and making sure she drilled out all the new cavity. This is where I have to really express my thanks to you guys. I got billed $135 for an hour's worth of work. I can't imagine a medical doctor spending an hour with me, and only billing $135. I trust her implicitly, because she always puts our health first, and $$ second. Never tries to sell me on the whitening procedures LOL, thank goodness!!

You sound like my kind of dentist!!
Thank you for the nice words. It is good to know that there are dentists out there doing good and that patients recognize it. There are stinkers in every profession and they get most of the press. I know that most dentists care very much about their patient's well being and are not looking to make extra money off of them. I (and many others) honestly believe that you can make a perfectly good living as a dentist by always watching out for your patient's best interests and never doing anything you would be ashamed to tell your kids about.

I was actually forced to retire early (at 35) due to YO Parkinson's, but I very much miss working with patients. Nothing better than taking someone out of pain or seeing someone who has been ashamed to smile for years looking in the mirror thrilled.
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Old 09-27-2013, 06:31 AM   #162
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Originally Posted by kellylfitz View Post
I said I wouldn't post again, but I feel the need to correct this because it is patently false. If something is not covered by insurance, then it is the patient's responsibility. If a patient wants veneers to make their teeth look better, no insurance company in the world will cover it, but you bet that the patient will be paying for it. If the insurance company decides that the patient could have had a filling instead of a crown (regardless of the fact that the patient really needed a crown), then the patient will be paying for it. An insurance company trying to dictate what a dentist can and cannot do outside the scope of the policy has been found illegal in multiple states.

Insurance companies are in it for their own profit and the patients ideal care is not their number one priority. The only thing the insurance company does is force the dentist to set his rates according to their fee schedule. A dentist can't charge the patient more than the insurance company's set fee and then collect the remainder from the patient.
For HMO and PPO type insurance correct, bt even with a PPO type coverage, they can charge the difference between what is allowed and what the insurance company actually pays. . My dental coverage is minimal, I don't like the HMO and PPO plans for dental care and I have found that most of these dentists do things just to get paid even if they aren't needed, at least in my experience. Anyway, my insurance pays next to nothing and my dentist charges me the full difference, and I pay because I love him, and that is saying a lot for me to love a dentist. lol

YOu don't have to agree to the contract with a certain insurance company, if you do them you are correct, otherwise they are free to charge as they see fit.
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Old 09-27-2013, 06:40 AM   #163
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The factbthat this guy went to school for 8 years and successfully worked on your 15 month old makes him a hero and he deserves way more than $110. In fact most would have put your kid to sleep which would have been far more money
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Old 09-27-2013, 06:53 AM   #164
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For HMO and PPO type insurance correct, bt even with a PPO type coverage, they can charge the difference between what is allowed and what the insurance company actually pays. . My dental coverage is minimal, I don't like the HMO and PPO plans for dental care and I have found that most of these dentists do things just to get paid even if they aren't needed, at least in my experience. Anyway, my insurance pays next to nothing and my dentist charges me the full difference, and I pay because I love him, and that is saying a lot for me to love a dentist. lol

YOu don't have to agree to the contract with a certain insurance company, if you do them you are correct, otherwise they are free to charge as they see fit.
This is us too I love our dentist even when he jokes about selling me teeth whiting treatments.

Our dentist has contract with all his patients that he charges x and x and what insurance doesn't pay we pay.
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Old 09-27-2013, 06:56 AM   #165
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Originally Posted by kellylfitz View Post
Thank you for the nice words. It is good to know that there are dentists out there doing good and that patients recognize it. There are stinkers in every profession and they get most of the press. I know that most dentists care very much about their patient's well being and are not looking to make extra money off of them. I (and many others) honestly believe that you can make a perfectly good living as a dentist by always watching out for your patient's best interests and never doing anything you would be ashamed to tell your kids about.

I was actually forced to retire early (at 35) due to YO Parkinson's, but I very much miss working with patients. Nothing better than taking someone out of pain or seeing someone who has been ashamed to smile for years looking in the mirror thrilled.
Dentist seem to be the red head step kids in the insurance world.

I love our dentist, recommend him to every one in the area, because I want him to stay put and be able to support his family.
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