Opinions ASAP! 5 year old son needs extensive dental work insurance wont cover anesthesia
angelrue522
member
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???????
Re: Opinions ASAP! 5 year old son needs extensive dental work insurance wont cover anesthesia
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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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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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.
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.
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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