School-Aged Children

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

  • First and foremost, the procedure is not normally considered health care, but dental care.  And your health care insurance is not there to provide dental care.  

    So instead of questioning why your health care policy won't cover a dental procedure, ask why your dental care policy doesn't cover general anesthesia in a hospital setting, since this is actually something that happens more often than nought.

    I am not trying to be pissy, really I am not.  I think our dental insurance system sucks worse than our health care system.  And they get away with situations like this because they can happily point to the HMO as being the bad guys, when really this is a DENTAL CARE issue, not HEALTH CARE issue.

    My suggestion is to continue your appeals process (your HMO Plan will tell you how many appeals you have, with each appeal moving further up the hierarchy) and provide additional medical necessity documentation.  

    If that does not work, you will have to do it piece meal.  

    I will tell you this.  Not ONE of my baby teeth fell out on it's own.  I had to see an oral surgeon to remove each one.  The nitrious may just work.  It did for me.   

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  • Ditto Ilumine. Unless you can show that there is a medical issue I cannot imagine why your insurance would pay for a voluntary hospital procedure. I get why this is frustrating but your kid not wanting to sit still does not mean an insurance company will pay thousands of dollars. My suggestion would be to look up sedation dentistry in your area and see if they will do it with kids. It is more than has and less than general anesthesia and is cheaper if you need to pay out of pocket. Also have you found out what is causing this bad of issues with the teeth?

    ETA: not all dentists are honest and some are more like sleazy used car salesmen. I had a pediatric dentist tell me my child has a cavity and then explain that it was not a cavity but really a natural groove and that it needed a filling and I did it. Afterwards I found out many dentists would have buffed it out. I also had a dentist tell me the reason so many orthodontists do orthodontics so young is that they have a patient for so long and that dentists call then space savers as in saving a space in the practice. They will make a lot of money if you do it in the hospital so they have a vested interest.
    Jen - Mom to two December 12 babies Nathaniel 12/12/06 and Addison 12/12/08
  • I agree with PPs.  Health insurance doesn't cover dental unless it is an accident.  And being scared of the dentist doesn't justify (to the health insurance company) paying a much higher cost for him to have the procedure in a hospital under general anesthesia. I agree the nitrous will probably work better than you think and maybe an anxiety drug like valium (maybe that's the liquid medicine?).

    Not knowing much about your situation, why are you having this work done on his baby teeth?  My kids starting losing teeth at 5....I would hate to put them through all that work to have the teeth start falling out on their own shortly after.  Is pulling them, instead of repairing them, an option? 

    Miracle Twins after 2 years TTC thanks to IVF! 10*18*06
    Lilypie - (6EmG)


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  • I'm also curious which teeth need the work done. My son had small pits in his back molars that we had to have fixed only because they keep those molars for so many years. Had the same issue been with other teeth we wouldn't have had them fixed as our dentist doesn't recommend dental work on young children unless absolutely necessary.

    i would perhaps consider a dentist who tries nitrous before going to extremes. There is a dentist in our town that sedates all children, and honestly that makes me nervous. I was so relieved when our dentist told us that they avoid that at almost all costs due to potential side effects. Nitrous can be very helpful with young children. And when the procedure is over they can switch to oxygen for a minute to clear out all effects of the nitrous before you even leave the office. 

    Hawaii
  • Can you access a dental school for care?

    FWIW, DS's dental policy would cover work but not what they deemed "behavior management"- aka the slug of Valium that allowed him to relax enough to have a deep molar filling done with nitrous oxide and Novocaine. DS, who has an ASD with sensory issues and ADHD, did really well with this combo. But I know of a lot of lower functioning kids who were so anxious they broke through the effects of the medication and needed to be hospitalized.

    I'm curious about why your son needs so much work done at age 5. I can't imagine crowns on anything but a molar at this age. Are you really struggling to get his teeth cleaned twice daily? Does he have some sort of congenital enamel issue (DS had a fissure on one of his primary molars)? Does he eat a sugary and sticky diet? Sometimes these sorts of dental issues can result from a behavioral health or developmental condition. Kids with SPD, for instance, can be real bears around cleaning.

    I moderate a forum for parents of kids on spectrum- many of them have similar stories to yours. One thing that is rampant in the practice of dentistry is holding mom responsible for a child who needs that level of treatment. Could this be coloring the answers you are getting at the office.

  • Personally, I would get a second opinion before putting my kid through that, especially at that age when the teeth will be falling out soon.....

    When I was little I had a dentist tell my mom that I had to have 3 fillings and he did something (I don't remember off hand) but ended up killing one of my baby teeth.  Before she allowed the dentist to do any more "work" she switched us, and he said that thank goodness he didn't do any other work, because he did enough damage to the one baby tooth, and the "cavities" that needed fillings were just pin pricks at the surface, and there was no need to take care of them at that point in time, they would fall out before giving me issues....My first filling was done when I was in High School.....I do not trust dentists (as you have to watch for doctors, car sales men, etc) just for that bad experience.....

    That is why I would cancel and look for a second opinion before moving on with the procedure.
  • image smsalat:
    Personally, I would get a second opinion before putting my kid through that, especially at that age when the teeth will be falling out soon.....

    When I was little I had a dentist tell my mom that I had to have 3 fillings and he did something (I don't remember off hand) but ended up killing one of my baby teeth.  Before she allowed the dentist to do any more "work" she switched us, and he said that thank goodness he didn't do any other work, because he did enough damage to the one baby tooth, and the "cavities" that needed fillings were just pin pricks at the surface, and there was no need to take care of them at that point in time, they would fall out before giving me issues....My first filling was done when I was in High School.....I do not trust dentists (as you have to watch for doctors, car sales men, etc) just for that bad experience.....

    That is why I would cancel and look for a second opinion before moving on with the procedure.

     

    Having had a dentist in high school that did way more work than needed, I definitely agree with the need of getting a second opinion. But the original poster said she already got a second opinion from another dentist. 

    Hawaii
  • 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.

    Both dentist have never been able to get good X rays, so I am not even sure if this amount of work is definite or not. My husband is very on the "anti" side of all this and thinks its all unnecessary.  The dentist had to explain to him that his teeth could lead to infection and this is for his protection. I am really not sure why he needs so much supposed work. We do brush twice daily, but he freaks out if we help him. Not a lot of candy or juice. Bad genes I suppose. I have root canals on many of my teeth.

    I call my son spirited b/c he fits into that category exactly, but with his emotional outburst still happening at this age, I wonder if it is something more. 

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  • image angelrue522:

    Both dentist have never been able to get good X rays, so I am not even sure if this amount of work is definite or not. My husband is very on the "anti" side of all this and thinks its all unnecessary.  The dentist had to explain to him that his teeth could lead to infection and this is for his protection. I am really not sure why he needs so much supposed work. We do brush twice daily, but he freaks out if we help him. Not a lot of candy or juice. Bad genes I suppose. I have root canals on many of my teeth.

    I wouldn't be getting any kind of work done if there aren't any "good xrays."  I think you need a 3rd opinion....while it is true that problems with teeth can lead to infection, no one seems to have a clear picture what issues there are (or not?).  Like I said previously, I would be incredibly reluctant to do all this work to baby teeth that could fall out a week later.  

    If he truly does have all these problems, brushing habits and diet really need to be revised.  Cut out candy and juice completely (kids don't need juice ever....water and milk are good enough...and soda never!).  Start looking into foods and snacks lower in sugar.  Maybe even consider a fluoride rinse at bedtime.

    Miracle Twins after 2 years TTC thanks to IVF! 10*18*06
    Lilypie - (6EmG)


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  • Ditto last post. Your dentist wants you to spend over 3K and put your child under general anesthesia without any real xrays. What if it turns out that the teeth are not that bad? I guarantee you te dentist would never admit it and will do all te work went the kid is under. Are the teeth bothering your child? I would ask around and like I said find a sedation dentist that if necessary could do it in office for a few hundred instead of 3k and no general anesthesia. A kind enough patient office might have better luck. Maybe ask to be the last visit so you will have more time. If the tooth hurts I would definitely get. Do you know which teeth and can you get your child to let you look? Does it look like a big cavity? And definitely ask what they think is happening and how to prevent it because a good dentist will have answers. I would also strongly suggest seeing someone about his behavior. I know some kids are anxious without other issues but your comments would have me concerned. Maybe a doctors office that specializes in Autism would be able to suggest a dentist.
    Jen - Mom to two December 12 babies Nathaniel 12/12/06 and Addison 12/12/08
  • rsd12rsd12
    Ninth Anniversary 1000 Comments First Answer
    member
    I can share my experience... We moved a year ago and before that my son went to the dentist every three months, since he was 12 months old. He is prone to cavities.

    He had fad cavities since he was 2. We started him on a topical fluoride to keep the cavities harder. They look ugly, but are firm enough. He is 7 now btw.

    We moved a year ago and a new dentist wanted to fill 4 cavities and cap 2 of his molar some ridiculous amount of money. We went back for a second opinion to his original dentist whom said not necessary, his teeth looked goud considering.

    In addition get will be having surgery I. The next year, so we want to wait to merge surgeries.

    We found a new dentist in our new town that was willing to meet us, listen to our needs, and recommended sealing these teeth since all but the molars will fall out soon enough.
    Boy 1 2/06 - Boy 2 12/07 - Boy 3 9/09
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