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Old 09-27-2013, 07:01 AM   #166
kellylfitz
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Originally Posted by mhsjax View Post
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.
Yes, very few insurance policies these days are indemnity plans where you have a certain pool of money to draw from until it is gone. Patients and dentists both love them, but they are expensive for employers and therefore pretty much only people who work in unionized jobs have them anymore.

Under an HMO, the dentist is paid a certain amount every month (a couple of bucks per patient on their list) and a certain amount for the procedure (very little) and can collect no more. I never took HMO plans because I felt like they motivated you to compromise your ethics because the reimbursement is so low. I could not have practiced dentistry to the standard I wanted without losing money if I took HMO's.

You are correct with PPOs that they will pay a certain percentage and then the dentist can collect the difference. The catch is that the dentist agrees to cap his fee at a certain amount for each procedures. For instance, the dentists normal fee schedule may be $150 for a certain type of filling. The insurance fee schedule will say that maximum you can charge is $110. So if a patient comes in and has the work done and the insurance company pays $80, the dentist is allowed to collect $30 and nothing more because of the contract with the insurance company.

Sorry for the off topic post OP, but hopefully there is some info people here can use. I hope your situation worked out for you.
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Old 09-27-2013, 07:48 AM   #167
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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
Again, that balance is after what the insurance company paid him. I'm not saying he doesn't deserve to be paid. I was only surprised because the insurance company said I would owe $50 and the bill was $110. BTW - the office billed me incorrectly, they said I only owe $85 ($50 + $35). Again, I am very thankful for insurance, but I'm not going to pay extra if I'm not supposed to be responsible for it. If I didn't call then they would have an extra $25 in their pocket and I'm not even talking about the 'Behavioral Management fee' here.
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Old 09-27-2013, 11:57 AM   #168
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Originally Posted by ThisIsTheYear View Post

Again, that balance is after what the insurance company paid him. I'm not saying he doesn't deserve to be paid. I was only surprised because the insurance company said I would owe $50 and the bill was $110. BTW - the office billed me incorrectly, they said I only owe $85 ($50 + $35). Again, I am very thankful for insurance, but I'm not going to pay extra if I'm not supposed to be responsible for it. If I didn't call then they would have an extra $25 in their pocket and I'm not even talking about the 'Behavioral Management fee' here.
It's good to review bills and call when there are items you are not expecting. People do that everyday. You should not ever pay for billing mistakes, just services rendered. But this thread seems to have take on a much more angry tone than calling about an unexpected charge on a bill (this is a collective issue, not just based on the OPs vent). It's unfortunate that your original info provided by insurance/dentist was incorrect as that's what started much of this frustration. Glad you have been able to reach agreement with the office
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Old 09-27-2013, 09:46 PM   #169
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I am just wondering about the two year old who already has had 3 cleanings and dental visits. Assuming visits are every six months it would seem your child had their first check up and cleaning at 6 months? Strange to say the least. My dentist waited until my children were 3 per my pediatrician and dentist. Also, to the OP, I agree that capping a tooth surely takes longer than 5 minutes. Sounds a bit exaggerated to me.
The AAP and Peds Dentistry are both moving towards establishing a dental home by age 12 months. It would be normal for a 2 year old to be having regular checkups. My children did - from the time the first tooth erupted! They have had great teeth and I attribute it directly to not waiting until they were 4 to start getting dental care.
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Old 09-27-2013, 09:50 PM   #170
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The AAP and Peds Dentistry are both moving towards establishing a dental home by age 12 months. It would be normal for a 2 year old to be having regular checkups. My children did - from the time the first tooth erupted! They have had great teeth and I attribute it directly to not waiting until they were 4 to start getting dental care.
I have 3 kids, (almost) 10, (almost) 13 and 15. They all started seeing the dentist at around 3 1/2 - 4. My 15 year old is the only one who has had a cavity, and just that one. They all have great teeth, and I attribute that to genetics and we parents teaching them good oral hygiene.
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Old 09-28-2013, 08:22 AM   #171
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Originally Posted by sookie View Post
The AAP and Peds Dentistry are both moving towards establishing a dental home by age 12 months. It would be normal for a 2 year old to be having regular checkups. My children did - from the time the first tooth erupted! They have had great teeth and I attribute it directly to not waiting until they were 4 to start getting dental care.
My daughter's first dentist Visit was when she was 3. She is now 13 and has never had a cavity. I attribute it directly to not giving her juice as an infant and practicing excellent oral hygiene - including brushing her gums before she got her first tooth.
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Old 09-28-2013, 08:34 AM   #172
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Originally Posted by kellylfitz

Yes, very few insurance policies these days are indemnity plans where you have a certain pool of money to draw from until it is gone. Patients and dentists both love them, but they are expensive for employers and therefore pretty much only people who work in unionized jobs have them anymore.

Under an HMO, the dentist is paid a certain amount every month (a couple of bucks per patient on their list) and a certain amount for the procedure (very little) and can collect no more. I never took HMO plans because I felt like they motivated you to compromise your ethics because the reimbursement is so low. I could not have practiced dentistry to the standard I wanted without losing money if I took HMO's.

You are correct with PPOs that they will pay a certain percentage and then the dentist can collect the difference. The catch is that the dentist agrees to cap his fee at a certain amount for each procedures. For instance, the dentists normal fee schedule may be $150 for a certain type of filling. The insurance fee schedule will say that maximum you can charge is $110. So if a patient comes in and has the work done and the insurance company pays $80, the dentist is allowed to collect $30 and nothing more because of the contract with the insurance company.

Sorry for the off topic post OP, but hopefully there is some info people here can use. I hope your situation worked out for you.
Thank you for this great explanation of HMO vs. PPO. I didn't know WHY we paid extra for the PPO plan, but never wanted to take the chance to find out why, KWIM? Ann, the life info I pick up on DisBoards! LOL!
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Old 09-28-2013, 08:40 AM   #173
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Originally Posted by sookie View Post
The AAP and Peds Dentistry are both moving towards establishing a dental home by age 12 months. It would be normal for a 2 year old to be having regular checkups. My children did - from the time the first tooth erupted! They have had great teeth and I attribute it directly to not waiting until they were 4 to start getting dental care.
My Ped. dentist only starts seeing them at 3, unless they have been referred by a doctor.

That's nice that those recommendations are being considered, but until they are accepted industry standards dentists will not accept them, nor will insurance pay.

Your attitude about your childs dental care is coming across snobby. Its nice that your child was seen by a professional for so long, but that doesn't negate the care given at home or by a doctor at a regular child visit, nor does it really have anything to do with this thread.
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Old 09-28-2013, 11:22 AM   #174
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My daughter's first dentist Visit was when she was 3. She is now 13 and has never had a cavity. I attribute it directly to not giving her juice as an infant and practicing excellent oral hygiene - including brushing her gums before she got her first tooth.
That might be nice, but I have to practice what I preach. I see way too many babies who are aged 1-2 years with rotted out, nasty teeth who just absolutely have to go to the dentist on an urgent basis - and they can't find one. They may have trouble finding one who will accept them because it is an urgent case. It is really awful when you get to that point.

Finding and establishing a dental home early is important because if your child develops an issue, you have a provider to go to early. You also start topical fluoride applications and other anticipatory guidance focused on dental care (AKA - What do you do when a tooth gets knocked out or injured badly? How do you access the provider?).

I will tell you that we had a thread here at the dis a few months ago with people talking about their dental hygiene, and it turned into a thread with people 1-upping each other on how many times a day they flossed and brushed. I think one woman said she brushed / flossed four times a day and a hygienist got on here and even told her at that point, she was probably damaging her gum tissues and her enamel.

So we may have a pretty great population here on the dis with people who brush twice a day and always floss. They may have children who never, ever get cavities, I can also tell you this: I see a general lack of dental care and a large number of dental caries in young children every single day in pediatric primary care practice. This is due to poor parental brushing technique, from a lack of care, and genetics. Some of those children are in pain due to the state of their teeth. If those children had been established early in a dental home and received anticipatory guidance and monitoring that focused directly on the developing teeth of children, it may have halted the sad state of the teeth I see in the kids I take care of. Many, when we do find a provider for them, end up going to the operating room for anesthesia to get their dental work done.

I can understanding people wanting to save $$$ by going with the OLD guidelines which used to be going to the dentist for your first visit at age 3 or 4 years - but times have changed and we now recommend establishing a dental home at 1 year. Those baby teeth are important to the overall health of the mouth and your child. You want to give them the very best care possible. But if you want to sit 4 years on that - by all means, go for it. But across the board, I have never seen dental insurance turn down preventative services for infants aged 1 year since I started practicing. I used to work for a hospital and was in administration and we had to track the billings of each department; we had a dental department. They were family practice dentistry and they also pushed for establishing a dental home at 1 year of age. We actually had to prioritize care for the little ones, those with chronic conditions, and adults because of where we worked - but kids and the chronically ill went to the head of the line to be seen.
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Old 09-28-2013, 12:15 PM   #175
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My daughter's first dentist Visit was when she was 3. She is now 13 and has never had a cavity. I attribute it directly to not giving her juice as an infant and practicing excellent oral hygiene - including brushing her gums before she got her first tooth.
Fluoride in city water helps too. My DD is 17 and no cavities. In my office, we are seeing a lot of teens that had no cavities as kids who now have tons of decay. Monster drinks and pop??? Lack of oral hygiene especially flossing. Bottled water instead of tap.
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Old 09-28-2013, 02:19 PM   #176
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My Ped. dentist only starts seeing them at 3, unless they have been referred by a doctor.

That's nice that those recommendations are being considered, but until they are accepted industry standards dentists will not accept them, nor will insurance pay.

Your attitude about your childs dental care is coming across snobby. Its nice that your child was seen by a professional for so long, but that doesn't negate the care given at home or by a doctor at a regular child visit, nor does it really have anything to do with this thread.
I can think back to over 4 plans that we had when we had young children under the ages of 3-4 and all paid 100% in network for preventative care.

And it isn't snobby. The establishment of a dental home by 1 year of age is the current recommendation by the leaders in Pediatric Dentistry (AAPD) and other providers should be following them.

http://www.aapd.org/advocacy/dentalhome/

http://www.aapd.org/assets/1/7/P_DentalHome.pdf

http://www.aapd.org/assets/1/7/Denta...erTooEarly.pdf

Just the cost difference is HUGE. Those who receive early care needed fewer procedures and work, saving money in the long run.

The American Academy of Pediatrics (AAP) also agrees and providers who are trained in pediatrics should be following that advice. If you are seeing someone who has not been trained in pediatrics (medical or dental, for that matter) or it has been a while since they have been updated in the field of dental health, maybe they have not received the memo. But this has been a consistent recommendation since at least 2007-2008, with many people doing it sooner.

http://www2.aap.org/oralhealth/

The Bright Futures program, our anticipatory guidance program, has also put out recommendations on this. This information is out there for providers to use. Not just in the dental field, but from the medical field as well. It should be addressed in well baby checkups and if it is not, you have a problem.

brightfutures.aap.org/pdfs/Guidelines_PDF/8-Promoting_Oral_Health.pdf

This is educational material for medical providers. This document even notes "The dental community (the American Dental Association, the Academy of General Dentistry, and the American Academy of Pediatric Dentistry) is united in encouraging families to establish a dental home by the time their child is 1 year old."

OP, I would find another Peds Dentist that works for you. I don't charge additional time if I have a crying patient. They all cry. Since you are so upset, I would be afraid you can't work with this doc again and I would find a new one.

Last edited by sookie; 09-28-2013 at 02:32 PM. Reason: Trying to get a link to work. And added some stuff.
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Old 09-28-2013, 02:29 PM   #177
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Fluoride in city water helps too. My DD is 17 and no cavities. In my office, we are seeing a lot of teens that had no cavities as kids who now have tons of decay. Monster drinks and pop??? Lack of oral hygiene especially flossing. Bottled water instead of tap.
Yes, you want them to be ingesting water with fluoride. Bottled water has none. You want it not only swallowed and ingested (cooked into your food too), but also washing over their teeth as they drink. Families with children in unfluorinated communities have a higher incidence of dental caries.
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Old 09-28-2013, 02:57 PM   #178
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OP, I would find another Peds Dentist that works for you. I don't charge additional time if I have a crying patient. They all cry. Since you are so upset, I would be afraid you can't work with this doc again and I would find a new one.
I WILL NOT be going back there! I actually talked to my dentists office today when I was there. They said they do treat children and do not charge any fees like the 'behavioral management' fee. What I like about them is they actually give you a sheet (and make you sign it) of what everything will cost, before they do anything. My son (7) should be fine there. Hopefully DD will forget her last traumatic experience and will be okay. Lol
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Old 09-28-2013, 03:08 PM   #179
luvmy3
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Originally Posted by sookie View Post
Yes, you want them to be ingesting water with fluoride. Bottled water has none. You want it not only swallowed and ingested (cooked into your food too), but also washing over their teeth as they drink. Families with children in unfluorinated communities have a higher incidence of dental caries.
We don't have fluoride in our water here and like i said previously my kids have great teeth. The pediatrician will prescribe fluoride vitamins for those who don't ahve it in their drinking water. That combined with toothpaste and rinse is enough for most of the population that does not have it in their drinking water (as per our dentist).
While I see nothing wrong with encouraging parents whose 1 year olds have issues to see the dentist, there are plenty of kids who won't need to until age 3. Maybe if I saw this epidemic of 1 and 2 years olds with rotten teeth, but I can't say I ever have
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Old 09-28-2013, 04:44 PM   #180
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I can think back to over 4 plans that we had when we had young children under the ages of 3-4 and all paid 100% in network for preventative care.

And it isn't snobby. The establishment of a dental home by 1 year of age is the current recommendation by the leaders in Pediatric Dentistry (AAPD) and other providers should be following them.

http://www.aapd.org/advocacy/dentalhome/

http://www.aapd.org/assets/1/7/P_DentalHome.pdf

http://www.aapd.org/assets/1/7/Denta...erTooEarly.pdf

Just the cost difference is HUGE. Those who receive early care needed fewer procedures and work, saving money in the long run.

The American Academy of Pediatrics (AAP) also agrees and providers who are trained in pediatrics should be following that advice. If you are seeing someone who has not been trained in pediatrics (medical or dental, for that matter) or it has been a while since they have been updated in the field of dental health, maybe they have not received the memo. But this has been a consistent recommendation since at least 2007-2008, with many people doing it sooner.

http://www2.aap.org/oralhealth/

The Bright Futures program, our anticipatory guidance program, has also put out recommendations on this. This information is out there for providers to use. Not just in the dental field, but from the medical field as well. It should be addressed in well baby checkups and if it is not, you have a problem.

brightfutures.aap.org/pdfs/Guidelines_PDF/8-Promoting_Oral_Health.pdf

This is educational material for medical providers. This document even notes "The dental community (the American Dental Association, the Academy of General Dentistry, and the American Academy of Pediatric Dentistry) is united in encouraging families to establish a dental home by the time their child is 1 year old."

OP, I would find another Peds Dentist that works for you. I don't charge additional time if I have a crying patient. They all cry. Since you are so upset, I would be afraid you can't work with this doc again and I would find a new one.
Obviously, I do believe in my kids seeing the dentist by age 1, as I had them both in there at that age. However, my reason was really just to get them to know our dentist as a friendly person who helps keep their teeth healthy. I think it's so important for children to have their parents expect that they will:

1. go to the dentist
2. have good checkups at these early visits (barring some unforeseen circumstance)
3. act appropriately

Over the years, I've met families where the parents are afraid of the dentist, and their kids are too. I don't love going there; sometimes I have a cavity. But I've always figured if we started going when they were really little, odds were in our favor that we'd have lots of pain-free visits to build up a good relationship.

OP, the above is not critique of you. Young kids sometimes get cavities, and good for you for getting your dd in there early. Can you imagine that cavity if you waited til she was 3 or 4?
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