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Opinions ASAP! 5 year old son needs extensive dental work insurance wont cover anesthesia

After getting 2 opiniions from different dentists, my 5 year old ( VERY spirited/stubborn) son needs 4 crowns and 2 fillings on his baby teeth. We have United Heath and dental insurance. Every dentist Ive spoke with is requesting we do it under general anesthesia in a surgical/hospital setting. We submitted the pre-auth. claim and my health insurance denies the portion for doing it in a hospital setting under anesthesia. We appealed the claim and Ive spent hours on the phone with dentists, and United. Dental covers the procedures, but not the hospital portion or anesthesia. My health insurance say it only covers it for accident issues. 

My son will not even hold still for an X Ray. He freaks out. Since my health insurance are being bastards, I now have an appointment tomorrow for it to be don in the dentist. They are going to give him a combination of liquid medicine ( supposed to relax him) then attempt the procedure. They also have nitrous available. I doubt this will even subdue my son since he freaks out so much. Im so upset. This is why I work and pay for health insurance for things like this. Now I have to put my son through drugging him up and he is already terrified of the dentist. Am I missing something? Ive heard other moms do it in a surgical center? Why will my insurance not cover it? 

Anyone have advise for me? Im terrified for him. And he will have to have a 2nd apt. after this one, when if I could just have it done under general anesthesia It would all be done in one shot.

Opinions  please??????? 

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Re: Opinions ASAP! 5 year old son needs extensive dental work insurance wont cover anesthesia

  • How much will it be out-of-pocket if you have it done at the surgical center? I think I would ask to set up a payment plan with them and go that route.
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  • Most dentists will set up payment plan options

     Or do you have a flex benefit account?  Of HSA?  Those things are usually covered under flex benefits and HSA's

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  • Nitrous could help a lot more than you think.  I'm super-anxious during dental procedures and when I got nitrous, I was completely relaxed and nothing bothered me at all. 

    I metabolize painkillers really quickly, so usually I'm freaking out during my procedures because everything's wearing off.  In the future, I'm just going to jones up the extra money for nitrous because it helps so much with my anxiety.

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  • I would also look into paying for the anesthesia if things go badly quickly tomorrow.

    I agree that nitrous can be helpful but if your son is really anxious, actually keeping the mask on to get it might be a challenge, it is not the most natural/normal feeling even for an adult. I wonder if insurance would cover if you 'gave it a try' wihtout and the dentist could attest to the fact that the work cannot be done safely? GL :(

  • image groovygrl:

    I would also look into paying for the anesthesia if things go badly quickly tomorrow.

    I agree that nitrous can be helpful but if your son is really anxious, actually keeping the mask on to get it might be a challenge, it is not the most natural/normal feeling even for an adult. I wonder if insurance would cover if you 'gave it a try' wihtout and the dentist could attest to the fact that the work cannot be done safely? GL :(

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    Have you taken him to a pediatric dentist?  My nephew had to have quite a bit of dental work done at a young age and the pediatric dentist was worth it for my sister (he was out of network for her).  They are better equipped to handle young kids.  They use nitrous on kids and my nephew loved showing off which "nose" he picked from the dentist (the nitrous masks are scented and he got to pick out which one he wanted).   He's 10 now and has never had an issue with going to the dentist.

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  • Yes. They are all pediatric dentists. They say it would be around 4k to do it at a surgical center b/c it would not be covered by insurance. I guess I will just hope for the best and see what happens tomorrow. :(
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  • At age 5,  most kids are able to handle dental treatment in office with or without  some form of sedation. Four crowns and two fillings for a healthy five years old would typically not be a candidate for receiving treatment under general anesthesia. I would assume your insurance company wants to make sure you have exhausted every option available to you; general anesthesia would be the last resort for a healthy 5 years old with the amount of dental treatment your son needs.

    I assume he will be getting treated by a pediatric dentist; they should be able to get this treatment completed in one visit. The oral sedation works remarkably well. He will be drowsy and relaxed. He will be able to breathe on his own and the recovery is faster. Talk to your son and let him know he is getting his teeth fixed so he won't have sick teeth, can eat his favorite foods, smile and talk well. You also should remind yourself that he is getting the treatment done because he needs it and the least invasive method would be the best. Get to the appointments early and follow the dentist instructions. Ask questions and try to relax; if you are stressed your son will most likely sense that and get worked up. Good luck and hope it all goes well Let me know if you have any other questions or concerns; I am a licensed practicing dentist.

  • My extremely sensitive (SPD) niece tolerated a filling with only local anesthesia and no sedation at about age 5, so you might be surprised.  Try to relax and be positive for your son. I agree with PPs that less sedation might be better.  It carries less risk and fewer side effects afterward. 


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  • image groovygrl:

    I would also look into paying for the anesthesia if things go badly quickly tomorrow.

    I agree that nitrous can be helpful but if your son is really anxious, actually keeping the mask on to get it might be a challenge, it is not the most natural/normal feeling even for an adult. I wonder if insurance would cover if you 'gave it a try' wihtout and the dentist could attest to the fact that the work cannot be done safely? GL :(



    Yah, recall from when I've had nitrous, everything is all buzzy and everyone talking sounds like a Donald Duck movie on fast forward. When they reduce the N and give more Oxygen, can be very unnerving if you dont know to expect it.
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  • my DD who has an extensive medical history and is terrified of any doctor office and freaked out at the dentist did fine sedated with versed and nitrous.  however hers was only for 2 small fillings and sealants.

    honestly if your pedi dentist recommends GA Id find a way. 4 crowns is very entensive. versed only lasts 30 minsutes and you will be in there hours. NO dental office can handle that type of deep sedation. It is much safer to go the GA route.

    talk to the hospital. discuss payment, cash pay etc.

    when i paid for sedation i had to pay 100% out of pocket for the sedation part (maybe $300) 

    so sorry 

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  • image angelrue522:

    Now I have to put my son through drugging him up and he is already terrified of the dentist.

    General anesthesia is more "drugging up" a kid than nitrous oxide.  I had to have nitrous oxide as a kid, when I was terrified of getting baby teeth pulled.  I realize that's a far less invasive procedure, but the terror was still there.  It was a HUGE help - I stopped freaking out long enough for the doctor to do what he needed to do.  I would give it a try before spending $4k to get him fully knocked out for the procedure.

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  • You guys, she is talking about a 5 year old getting 4 crowns, not just one filling. As an adult, it was a lot for me to sit through one crown. OP, I would definitely look into a payment plan for the anesthesia and go that route. I am sorry you are in this position :(
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  • I'm so sorry. No advice but I wish you luck. :( My DD needs 2 fillings and she will also FREAK OUT so I am very worried about how that will go. We don't have anything scheduled yet as the dentist is trying to buy some time first. She can hardly get through a regular appointment b/c she's scared the mask, and she hates loud/weird noises so I can't imagine how she will handle the noise with the fillings. 
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  • Thanks for all your replies. This is what happened at his apt today. Went into office they had to force the liquid medicine down him and he freaked out. We waited about 45 minutes. He seemed a little sleepy but that's about it. We took him back and he refused to even sit in the chair or put the mask on. After trying for about 25 more minutes with no success, it was never going to work and we just left. Guess we will be paying $3100 out of pocket for a surgical center.
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  • What about an oral surgeon?  They may be able to do it inhouse and still do general.  
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  • So sorry for the stress your poor son.
    And you too.
    Ga is the way to go and won't cause the fear or fighting since he will be out.
    They should be able to work. Payment plan though 3100 seems low. Maybe from a positive slant at least you maeet your deductible or out of pocket max sooner this year!
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