Pediatric Dentist- holy crap$$$$$

[zarapipe]

DD's "little tiny" cavity because of her love of gummy vitamins after brushing her teeth is going to cost $360 with insurance.

A cleaning- $74

Varseed/Valium non IV meds- $213

Floride- DOES SHE NEED THIS? $36

Filling- $189

Total of $512, insurance will pay $176.50, which leaves me $360.50.

Insurance doesn't cover the whole cleaning because their price is more than what they allow, nor do they pay 50% of the filing because it is more than 50% of what they allow.

GRRRR

She does need the meds I think. The filling would scare the living crap out of her.

Does this sound reasonable?

[savan]

Did she not have a cleaning already? One that discovered the cavity?

I think I paid $100 with insurance for DS's cavity but that was without a cleaning, fluoride (which seems to be standard for small kids), or meds. He was 6 and did just fine without any extra help.

[iamali]

Seems the norm to me.

DS2 has crummy teeth and it's the sedation that costs the most IME. Most insurance doesn't cover it.

[illgetthere]

That might be reasonable considering you are using an out of network dentist. I would seriously look at finding someone in network; I have previously paid nothing for cleanings and less than $20 for a cavity. S was 7 for his cavity, and they didn't do anything for him that they don't do for adults. He also loves the dentist though (he's a weird one).

Edit: is the cleaning charge in addition to the cleaning she just had done?  i.e. are they cleaning again when they fill the cavity?

[chikastuff]

I have no idea of what's normal or not, but dental work is almost always $$$.

Perhaps get a second opinion before you proceed? I mean, what constitutes a "little tiny" cavity? is it an actual cavity or is it just a weak and maybe pitted spot? I'm assuming this is a baby tooth? Could they clean it and seal it instead of doing a full filling?

[ladyk]

Also, can you get sealants on the rest of her teeth?

[gingery]

Have you thought of looking for a provider in your insurance's network? That would help as the fees would be capped at the negotiated amount.

[dbsk8dance]

I just paid $180 for just a cleaning OOP. 

We don't have dental on DS because it's more than the $360 we'd need to pay for the 2 cleanings. 

[zarapipe]

ladyk they said they don't typically do sealants on baby teeth

She didn't get a cleaning the first time, just xrays and being poked with the little tooth instrument.

[zarapipe]

There is only one pediatric dentist in network in my area and they are 45 minutes away.. So far with it being out of network we are responsible for an additional $10 for the cleaning and an additional $20 for the filling, so $30 more, not much.

Yelp reviews are notta... small community so it's not a good resource.

She gets well water at home  and city water at preschool- I would guess she gets plenty of floride? I have no idea though...

[SusanBAnthony]

I would get an opinion from an in network dentist.

And I question filling little tiny cavities. Most good dentists take more of a wait and see approach to little cavities. Have they mentioned the cavity at her last appt. six months ago? If not, I would ask towa it six months and see if it is any bigger.

Actually I would just switch dentists. Why see an out of network one and pay more?

[SusanBAnthony]

A good regular dentist is better than a crappy pediatric dentist.

[zarapipe]

Jan 13, 2014 15:30:36 GMT -5 SusanBAnthony said:

I would get an opinion from an in network dentist.

And I question filling little tiny cavities. Most good dentists take more of a wait and see approach to little cavities. Have they mentioned the cavity at her last appt. six months ago? If not, I would ask towa it six months and see if it is any bigger.

Actually I would just switch dentists. Why see an out of network one and pay more?

It's actually been closer to a year since she has been seen. They did not mention a wait and see approach, just said to fill it now because she will have this tooth for a while, it is one of her molars, her last one on the left side.

[glynn]

We paid a little over $3,000 for 5 caps on DD's crappy teath all out of pocket with no insurance. She was put to sleep because she just about will not let them even look. She had cavties already and boken teeth.

[Ashley&Scott]

Did they check to see of her medical insurance will cover the meds?

I don't think the prices are bad since. Have you talked to the dentist about being out of network? Sometimes they have different rates of payment plans.

I wouldn't skip any of the treatments he recommended. Ask again about sealants, we had M 'a molars sealed. I think it was $50/tooth. Definitely get the fluoride, it helps strengthen the tooth enamel.

I'm sure you've already done this but make sure she gets her vitamin before brushing & brushes really well after.

[barefootcontessa]

my favorite is that our insurance will not pay for any sedation (not even laughing gas) for children. supposedly a four year old will sit still for the giant shot. we have to pay like $150 for the laughing gas or else $600 for IV sedation. I am surprised your insurance does not cover the floride.

[caramia17]

I am a dentist, but not a pediatric dentist and not your child's dentist. This is not medical advice. I do not know your area and pricing for medical procedures, like anything, has a community standard. That said, the prices don't seem so out of line. How many surfaces is the filling and what materials are they using? In office topical fluoride is different than fluoride that is taken in the water supply and its effect on the teeth is different. $36 seems cheap for prevention to avoid another $500 bill.

Don't forget that the advantage of a pediatric dentist is the behavior management and sedation training and monitoring that most of them have. They have 2 years of additional training beyond dental school dealing with kids and get the "bad" cases (far gone decay, kids who are really young and/or afraid, etc.) referred to them regularly. They have to be quick and gentle and that expertise and training do cost.

You can figure out if the time spent going to an in-network provider is worth it to you or not, but if you like this dentist and are comfortable, I would proceed with your child's care at that office. If you don't feel comfortable, that is a whole different story and you should seek care elsewhere.

Good luck!

[zarapipe]

Jan 13, 2014 15:54:09 GMT -5 Ashley&Scott said:

Did they check to see of her medical insurance will cover the meds?

I don't think the prices are bad since. Have you talked to the dentist about being out of network? Sometimes they have different rates of payment plans.

I wouldn't skip any of the treatments he recommended. Ask again about sealants, we had M 'a molars sealed. I think it was $50/tooth. Definitely get the fluoride, it helps strengthen the tooth enamel.

I'm sure you've already done this but make sure she gets her vitamin before brushing & brushes really well after.

Thanks for the idea of medical insurance- doesn't hurt to check.

and yes- the vitamins. That has stopped, vitamins, teeth brushing and then preschool. As soon as he saw the cavity he asked if she has gummy vitamins- I never would have thought that would have been worse than the juice/milk, etc.

[zarapipe]

Jan 13, 2014 17:58:47 GMT -5 caramia17 said:

I am a dentist, but not a pediatric dentist and not your child's dentist. This is not medical advice. I do not know your area and pricing for medical procedures, like anything, has a community standard. That said, the prices don't seem so out of line. How many surfaces is the filling and what materials are they using? In office topical fluoride is different than fluoride that is taken in the water supply and its effect on the teeth is different. $36 seems cheap for prevention to avoid another $500 bill.

Don't forget that the advantage of a pediatric dentist is the behavior management and sedation training and monitoring that most of them have. They have 2 years of additional training beyond dental school dealing with kids and get the "bad" cases (far gone decay, kids who are really young and/or afraid, etc.) referred to them regularly. They have to be quick and gentle and that expertise and training do cost.

You can figure out if the time spent going to an in-network provider is worth it to you or not, but if you like this dentist and are comfortable, I would proceed with your child's care at that office. If you don't feel comfortable, that is a whole different story and you should seek care elsewhere.

Good luck!

Thank you. This is very helpful. I do like the current dentist, the practice is amazing, they were wonderful with DD, so we wont switch. I think the shell shock has gotten me though.

It is one surface- It says Resin-1 surface, posterior.

[sweetnsour]

Are you sure that she needs to have drugs? My 5 year old was able to sit through a filling with no issues but you know your child best. We also have well water and I give my kids fluoride supplements prescribed by the doctor.

[caramia17]

Is the code D2330 or D2391?

They would both be listed as "one surface resin" but are different procedures.

Either way, the UCR (usual, reasonable, and customary) seems within the range of normal.

PM me if you have other questions.

[zarapipe]

Jan 13, 2014 18:41:54 GMT -5 sweetnsour said:

Are you sure that she needs to have drugs? My 5 year old was able to sit through a filling with no issues but you know your child best. We also have well water and I give my kids fluoride supplements prescribed by the doctor.

Yes, I'm sure. She will freak out, start vomiting, screaming. They would have to hold her down, but I'm not even sure they would attempt it without drugs. Hopefully in a few years.

And yes @fivedogs they should be outlawed. After our jar is gone we are getting chewable. I feel so stupid for not realizing they would get stuck up in her teeth.

[SusanBAnthony]

Ditto others that she may be ok without sedation. Obviously it is a totally different procedure, but DS had to have an MRI last year. The doctor said NO WAY would a five year old be able to do it (they have to hold perfectly still for 45 minutes and it is loud). DH totally freaks out about anesthesia and so he worked with DS for a week beforehand, practicing for it, watching you tube videos, etc. DS rocked it, which saved us hundreds of dollars, hours of our time, and of course DH was happier, lol. So if you think she might be able to, you might ask the dentist if she can try without sedation first.

eta: oops, we posted at the same time, never mind.

[jloww]

Jan 13, 2014 15:23:39 GMT -5 zarapipe said:

ladyk they said they don't typically do sealants on baby teeth

She didn't get a cleaning the first time, just xrays and being poked with the little tooth instrument.

This is too bad.  Our pediatric dentist would like to put them on DS when he is 8 because he has very deep grooves.  I had them as a kid and I think they are a huge part of not having any childhood cavities. 

[anna7602]

Jan 13, 2014 19:31:23 GMT -5 @fivedogs said:

Also, I'm so sorry - those gummy vitamins are the devil.

Agreed. Our dentist advised against them when DD went for her visit at age 2.5. I was so surprised I had never heard anything said against them before that. 

ETA: good luck with everything! Fwiw, sometimes kids just have cavity-prone teeth. My brother and I grew up with the same diet and brushing habits. He never got a cavity as a kid, I had them all the time. 

[caramia17]

Jan 13, 2014 21:42:25 GMT -5 jloww said:

Jan 13, 2014 15:23:39 GMT -5 zarapipe said:

ladyk they said they don't typically do sealants on baby teeth

She didn't get a cleaning the first time, just xrays and being poked with the little tooth instrument.

This is too bad.  Our pediatric dentist would like to put them on DS when he is 8 because he has very deep grooves.  I had them as a kid and I think they are a huge part of not having any childhood cavities. 

At 8, it is probably permanent teeth, "6 year molars", if you will. They are done on primary teeth, but they likely wouldn't wait until 8. Your primary molars are in around 2 years old.

[jena]

Jan 13, 2014 21:05:41 GMT -5 @fivedogs said:

Jan 13, 2014 20:46:30 GMT -5 swizz said:

They don't pull the ones in the back because they are supposed to be there for so long. You don't lose all your baby teeth until sometime in middle school I think? That's a long time to go toothless.

DD had a cavity filled this summer. There are no pediatric dentists on my insurance near me except the big chains that advertise cheap cleanings and DH refuses to go to one after a bad experience years ago. My insurance paid some, but I think the total bill was over $300 and we paid almost $300 of it.

Are those meds the stuff in the shots or something extra? DD's dentist is so good that DD has NO IDEA that she got 2 shots in her mouth. She used some numbing cream and a little slight of hand and it was done. It was amazing.

[jloww]

Jan 14, 2014 8:02:14 GMT -5 caramia17 said:

Jan 13, 2014 21:42:25 GMT -5 jloww said:

This is too bad.  Our pediatric dentist would like to put them on DS when he is 8 because he has very deep grooves.  I had them as a kid and I think they are a huge part of not having any childhood cavities. 

At 8, it is probably permanent teeth, "6 year molars", if you will. They are done on primary teeth, but they likely wouldn't wait until 8. Your primary molars are in around 2 years old.

That's really interesting!  I had no idea.  I assumed he was done teething.

[sent]

I am also a dentist but not a pediatric dentist and agree with what caramia17 wrote.

The fees look standard to me.  Insurance often doesn't cover dental work to a greater extent because it's not really insurance.  It's more like a benefit coupon to use toward treatment costs.  The meds are what is making the cost higher overall since the insurance won't pay anything toward this.  A pediatric dentist is trained to use these meds to make the experience better for your child.  The fluoride is valuable at her age.

The prices insurances allow for things are sometimes ridiculously low in a dental office depending on the plan.  They pay 50% up their allowed fee, not the fee the doctor sets.  So they are probably paying something toward your filling, just not 50% like they led you to believe.  If the fee from the doctor is equal to or less than the allowed fee, then the 50% makes sense.  Otherwise it's just a way for them to make it sound like they will cover 50% of the cost when in reality they won't.  The allowed fees are not based on any standards except what the insurance company decided is reasonable.  

[caramia17]

Jan 14, 2014 16:46:07 GMT -5 sent said:

I am also a dentist but not a pediatric dentist and agree with what caramia17 wrote.

The fees look standard to me.  Insurance often doesn't cover dental work to a greater extent because it's not really insurance.  It's more like a benefit coupon to use toward treatment costs.  The meds are what is making the cost higher overall since the insurance won't pay anything toward this.  A pediatric dentist is trained to use these meds to make the experience better for your child.  The fluoride is valuable at her age.

The prices insurances allow for things are sometimes ridiculously low in a dental office depending on the plan.  They pay 50% up their allowed fee, not the fee the doctor sets.  So they are probably paying something toward your filling, just not 50% like they led you to believe.  If the fee from the doctor is equal to or less than the allowed fee, then the 50% makes sense.  Otherwise it's just a way for them to make it sound like they will cover 50% of the cost when in reality they won't.  The allowed fees are not based on any standards except what the insurance company decided is reasonable.  

I have used the exact phrasing, "Dental insurance is like a Groupon" before in discussing care with patients. Except worse because there is a yearly maximum.