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

[Pea-n-Me]

I don't think I should have to pay $35 for being in the room and constraining my daughter.

Ok. I'm betting they'll drop the charge for you.

You should probably clarify with the dentist how charges work for future visits.

But, what could they have possibly done to manage her behavior? This is what I'm wondering.

Please don't take this as snark, it's not. But did you read the AAPD position paper? Some of your answers will be there, and the rest will come from the interpretation of how it went down from your particular dentist. I can assure you, you did not do the work alone, despite your being the one to hold your daughter for the procedure. It takes teamwork, and expertise of the staff, in order to have a successful experience. Do you think it's easy for a dentist to do such a procedure on a squirming, sweaty, uncooperative kid? It's not. He seems to have done a stellar, swift job. He assessed the situation, and intervened in ways you weren't aware of and ways he may not even be able to point out himself, because it becomes instinctual after a while; not something you think a lot about. (And of course, all this is based on education and training they've had because they are a specialty. If it was so easy, anyone could do it, right?) Put it this way: had your child been perfectly cooperative, there wouldn't have been a charge. Because she was upset, there was. Something had to happen in order to get the job done, and it did. That is the best I can explain it. I'm sure others may see it differently, but this is likely the way your dentist sees it. I do wish you well, and certainly hope this was helpful.

 

[kirstenb1]

Ok. I'm betting they'll drop the charge for you.

You should probably clarify with the dentist how charges work for future visits.


Please don't take this as snark, it's not. But did you read the AAPD position paper? Some of your answers will be there, and the rest will come from the interpretation of how it went down from your particular dentist. I can assure you, you did not do the work alone, despite your being the one to hold your daughter for the procedure. It takes teamwork, and expertise of the staff, in order to have a successful experience. Do you think it's easy for a dentist to do such a procedure on a squirming, sweaty, uncooperative kid? It's not. He seems to have done a stellar, swift job. He assessed the situation, and intervened in ways you weren't aware of and ways he may not even be able to point out himself, brcause it becomes instinctual after a while; not something you think a lot about. Put it this way: had your child been perfectly cooperative, there wouldn't have been a charge. Because she was upset, there was. Something had to happen in order to get the job done, and it did. That is the best I can explain it. I'm sure others may see it differently, but this is likely the way your dentist sees it. I do wish you well, and certainly hope this was helpful.

My children have always gone to my dentist, so I have no experience with pediatric dentists. But wouldn't you expect a certain amount of fidgety, upset behavior from young children getting fillings?

Kind of like the places that specialize in cutting children's hair. Again, I've never used them, but would guess they spend a little extra time with children who are anxious. Hopefully they don't charge an extra fee for that.

My thought is "behavior management fee" is something that should be reserved for really unusual situations. I wasn't there, so I don't know--maybe it was, maybe it wasn't.

 

[Pea-n-Me]

Probably so, Kirsten. But there must have been a reason why the AAPD felt they needed to come up with specific policies and guidelines for behavior management. I can't find it myself right now (have a dentist appt soon!) but in doing some research on this topic, I did see mention of it somewhere. I believe it was in a study, if anyone else wants to look.

 

[crisi]

My children have always gone to my dentist, so I have no experience with pediatric dentists. But wouldn't you expect a certain amount of fidgety, upset behavior from young children getting fillings?

Kind of like the places that specialize in cutting children's hair. Again, I've never used them, but would guess they spend a little extra time with children who are anxious. Hopefully they don't charge an extra fee for that.

My thought is "behavior management fee" is something that should be reserved for really unusual situations. I wasn't there, so I don't know--maybe it was, maybe it wasn't.

I suspect its an insurance issue. The insurance company wants to pay $x for a filling. They want to pay that if the filling is going into a three year old or a thirty year old. However, for a dentist there is additional costs in handling three year olds - they can't break even charging what insurance will pay - hence the behavior management fee - which could cover anything from toys in the waiting room or a tv in the treatment room to extra clamps and equipment to extra training that the staff in a pediatric dental office goes through to specialize to extra staff - that they may or may not use - to handle kids - to the box of pencils and stickers you get at the end of your visit.

When you go have your kids hair cut, the insurance company is not saying "we only pay $8 for a haircut - if it costs you more to specialize in kids hair, tough."

 

[AJKMOM]

I have a son with autism, and nobody ever was worse than he was for the first 3 years we went to a pediatric dentist. I can relate to being tired and sweaty after his appointments, I did most of the restraining, even when he was on Valium.

I never got an additional fee his behavior problems. In spite of it, he still goes to the same dentist at age 24, and is fairly well behaved. Not sure I would continue with a dentist who snuck an unexplained fee in on me. Good luck.

 

[ThisIsTheYear]

Ok. I'm betting they'll drop the charge for you.

You should probably clarify with the dentist how charges work for future visits.


Please don't take this as snark, it's not. But did you read the AAPD position paper? Some of your answers will be there, and the rest will come from the interpretation of how it went down from your particular dentist. I can assure you, you did not do the work alone, despite your being the one to hold your daughter for the procedure. It takes teamwork, and expertise of the staff, in order to have a successful experience. Do you think it's easy for a dentist to do such a procedure on a squirming, sweaty, uncooperative kid? It's not. He seems to have done a stellar, swift job. He assessed the situation, and intervened in ways you weren't aware of and ways he may not even be able to point out himself, because it becomes instinctual after a while; not something you think a lot about. (And of course, all this is based on education and training they've had because they are a specialty. If it was so easy, anyone could do it, right?) Put it this way: had your child been perfectly cooperative, there wouldn't have been a charge. Because she was upset, there was. Something had to happen in order to get the job done, and it did. That is the best I can explain it. I'm sure others may see it differently, but this is likely the way your dentist sees it. I do wish you well, and certainly hope this was helpful.

No I didn't. After the afterschool craziness, I will read it. I really should have read it before I contacted them. Thanks for the links!

 

[FairestOfThemAll37]

I almost never reply to these kinds of things as there's so much emotion, but after seeing this thread blow up here are my two cents which are just my opinion.

OP said that she should not have to pay the behavior management fee because she held her child and did all the work to calm her. She also said that the dentist instructed her on how to hold the child. That took time and skill to explain how to do that properly. Had he (or she) not been trained in that specific skill or instructed you correctly your child could have been injured thrashing about during the procedure.

 

[littlelulu33]

I used to work at a ped. DDS. We used charge for behavior management, but it was for kids that we needed extra assistance in the room staff not a parent and most of the time the kids needed to take a pre medication which also required extra attention.

 

[pfp258]

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.

 

[kirstenb1]

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.

Maybe the child is close to turning 3? Both my children started going by the time they were 1, so 3 visits would put them at age 2 1/2.

 

[akcire]

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.

She's 2.5. She had first visit at 18 months, next at 2, then third at 2.5. All her baby teeth were in by 10-12 months. Around here we were late to first apt. Typical here it is first tooth or 1 year. Now the appointments get progressively more involved. I'd say this last one was a full cleaning, dentist inspection, and fluoride treatment what I receive as an adult. Previous two were less complete based in her attention.

Her teeth are beautiful. She drinks only milk/ water no juice (allergy) or soda (not needed). Her teeth are brushed about 10 times a week. Always at night, sometimes in am.

Get this. I was advised I needed to be better about 2 times a day brushing and start flossing. Have not yet tried flossing her teeth but the hygienist had no problem doing it in the office. If these steps help keep her cavity free I'm all for trying, it sure was different than dental care I received growing up. My general healthcare philosophy focuses on non invasive preventative care-so why not well try flossing the tots teeth. It is pretty amusing to me that her dentist/hygienist are chastising me for not doing enough when here I'm reading about kids not going until 3 or 4. Maybe it's regional, or just different strokes??

 

[Granny square]

I almost never reply to these kinds of things as there's so much emotion, but after seeing this thread blow up here are my two cents which are just my opinion. OP said that she should not have to pay the behavior management fee because she held her child and did all the work to calm her. She also said that the dentist instructed her on how to hold the child. That took time and skill to explain how to do that properly. Had he (or she) not been trained in that specific skill or instructed you correctly your child could have been injured thrashing about during the procedure.

Seriously? I can teach a parent how to restrain their child in about 2 minutes flat. Not rocket science.

 

[Eastern]

I am not a doctor, dentist, clinic or hospital, but this is a totally unfair statement. Doctors and dentists for the most part pay huge for the "privilege" of being a professional. There are the schooling costs which are extensive in their own right, BUT think of the "hidden" costs both In training and in real life practice. Doctors/dentists sacrificed their free time, sleep, eating, basically their entire lives for studying, training, testing, licensing, etc. in most situations, until the day they retire they will have after hours call, on calls, emergencies, patients calling at home (paying for unlisted numbers another hidden cost), not to mention friends and family looking for free medical advice! Let's not even begin to imagine the malpractice insurance premiums they are covering! I think that most of them are NOT compensated enough for the sacrifices they and their families make daily! Compare their salaries, schooling, sacrifices, and expenses to that of your average politician before making such a disgusting statement. Off my soapbox now...... Sorry but this comment just hit me wrong!

Thank you, I think you covered all the bases! Maybe plastic surgeons in Beverly Hills are in it for the money but the vast majority of health workers are in it because they want to help people.

It is disturbing how threads about an 'incident' will often devolve into criticisms of entire groups of people. These types of statements wouldn't be tolerated for other groups, but for some reason, it is for health professionals. Try substituting nationalities, races, and religious affiliations into the statement "they are only in it for the money" and see how it sounds.

 

[ariel71]

Seriously? I can teach a parent how to restrain their child in about 2 minutes flat. Not rocket science.

Seriously? Within the confines of the chair, mom, dentist and assistant, with sharp instruments directly in the mouth and around the face, and needing to keep the head in an exact position for the extent of the procedure? You can teach that in 2 minutes? I have no dental experience but that seems like a pretty out-there statement in any context.

 

[Granny square]

For 28 years I have been one of the people in our state to train restraints to parents, teachers, treatment facilities and professionals including <gasp> dentists and docs. Lol, so yep, I can. The high costs of the training are absorbed by our mental health boards in hopes of people (kids and others who lack the understanding or ability) to NOT be traumatized, to be safe and to be able to receive the services needed within the least restrictive manner.

 

[WebmasterKathy]

She was screaming the entire time, they close the door and the assistant kept saying, "It's okay, shhh".

Screaming the entire time. That's the key, and the reason for the extra charge.

 

[emma'smom]

Write up your own invoice for 50 dollars for "Parental Restraint Fee" and then add on a 20 dollar processing fee. Send it to your dentist with a specified due date....and then send a "late notice".

 

[ThisIsTheYear]

Write up your own invoice for 50 dollars for "Parental Restraint Fee" and then add on a 20 dollar processing fee. Send it to your dentist with a specified due date....and then send a "late notice".

I'm also going to add a fee for 'extended waiting room time'.

 

[Pea-n-Me]

If you hurry, you might be able to sign up for this course on Friday!

The 7th Annual Robert J. Feigal Symposium
Managing Child Behavior in the 21st Century Dental Practice
6.5 credit hours ✧ Friday, September 27, 2013 ✧ Continuing Education & Conference Center ✧ University of Minnesota ✧ St. Paul Campus

http://www.dentistry.umn.edu/prod/groups/sod/@pub/@sod/@cde/documents/article/sod_article_441887.pdf

About the Course

The 2013 Feigal Symposium will give you a fresh perspective on pediatric behavior guidance techniques suited for today’s society and contemporary dental practice. A team of experts in the field will present key components to relationship building between the dental team, parent and child. You will come away from this program with the tools to provide your young patients with a positive dental experience.

The entire dental team will benefit from useful insights on how to:

• communicate with children and parents to allay fear and anxiety.

• assess a child’s developmental stage and tailor behavior guidance accordingly.

• utilize basic behavior guidance techniques—tell-show-do, voice control, nonverbal, positive reinforcement, distraction, and parental presence or absence.

• determine when advanced behavior guidance is necessary— protective stabilization, sedation or general anesthesia.

• identify the role of pre-operative analgesics, local anesthesia and nitrous oxide in managing pediatric pain and anxiety.

• develop a child-friendly environment that will facilitate behavior guidance and a positive dental experience.

 

[hereyago]

My dd's first dentist (don't get me started on how he and his office was) and her current dentist have ;scream" rooms. The rest of the area are open, so one patient can look over and see the other patient just counters separate.

My dd had to go to the scream room when 2 baby teeth were in the way of adult teeth coming in.

Her df and I were in there with her. Funny thing, she didn't scream. The numbing needle did make her go ow, but that was it. It was years ago, so I don't recall a fee except when I had them pay me for not notifying me that the dentist wasn't going to be at an appointment.