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
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.
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.
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.
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.
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.
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.