Mothering Forum banner

1 - 20 of 30 Posts

·
Registered
Joined
·
3,701 Posts
Discussion Starter #1
Long story short, I hope. Dd2 is 23 months old. She has 8 cavities. She needs them fixed ASAP. In Feb the second dentist we saw said he could do sedation in the office. He said we could do it in the hospital, but the soonest appointment would be May or June and he didn't think her teeth would last that long. She needed four molars filled and capped. Her four top teeth would either need to be filled and capped, have root canals, or pulled. He wouldn't know until the day of the sedation because he wouldn't know how bad they were getting. Fast forward to today. We go in for the sedation surgery. She spits out 3/4 of her meds. She's loopy, but not sedated. So we have to do it in the hospital, but not today. First we have to get approval from 3 different insurance companies. The dental, the medical, and medicaid, which is our secondary. It could be months. I tell them how much pain she is in. They give us a second round of antibiotics and Lortab. They say there is nothing they can do. I cried all the way home. I'm so angry. This is the second pediatric dentist. The first wanted to tie her down with no pain meds over 2-3 visits. I called the various insurance companies today (not medicaid because that's almost pointless) and the dental doesn't cover any of the hospital fees and the medical doesn't either because it's a dental procedure, not a medical one. I caleld the dentist office and tell them this. Also that the dental insurance does not require a preauth. Just repeating what I was told. Apparently these people are frustrated with me. I dont' know the things to tell the insurance companies to get them to pay for it so I need to just wait. Well, I want it done NOW, not months from now. I'm sorry if I called once or twice a week trying to see if they had cancellations for sedation. They TOLD me to. THere are probably notes all over her chart.<br><br>
So tomorrow I am calling and asking them if two months ago the dentist didn't think her teeth could wait until May of June why can they wait now? It doens't make sense to me Can't they do some sort of emergency something? WHat if they tell me no? What can I do? Is there anything I can do? She hurts. Sometimes she cries because her mouth hurts. It hurts me to watch her hurt. I have a hard time sticking up for myself and I'm learning to stick up for my kids. But what if they say there is nothing they can do?
 

·
Registered
Joined
·
4,153 Posts
<img alt="" class="inlineimg" src="/img/vbsmilies/smilies/hug2.gif" style="border:0px solid;" title="Hug2"> That's a toughie. The problem then is that you can't have it done at the hospital because the insurance companies won't cover it since it's not a medical procedure? I'd think that if the dentist were to talk to the insurance cos and explain the situation that it might be able to be classified as a medical procedure instead of a dental case. Just keep calling until you get an answer you can live with, and don't take no for an answer! I know how difficult it is, and I'm a lot like you, but when you feel yourself ready to give up and getting flustered then just think of your little one's pain and that will get you through.<br><br>
Also, is there any way you can just go ahead and have it done at the hospital and then sort the bill out later? You usually don't pay up front for hospital procedures, so maybe you could have them do it at the hospital and then resume the fight with the insurance companies after the fact?<br><br>
Hope you get it sorted out soon.
 

·
Registered
Joined
·
2,654 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>superstella</strong> <a href="/community/forum/post/7901646"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Also, is there any way you can just go ahead and have it done at the hospital and then sort the bill out later? You usually don't pay up front for hospital procedures, so maybe you could have them do it at the hospital and then resume the fight with the insurance companies after the fact?</div>
</td>
</tr></table></div>
This is what I would do. If she's in pain, just have it done. You don't have to pay up front, right? So I wouldn't think it would matter if the insurance stuff were worked out now or later.
 

·
Registered
Joined
·
2,149 Posts
DS1 had to have major dental work done in the hospital when he was young. We had dental insurance, medical insurance and medicaid as secondary insurance. The dental picked up the dental part and medicaid picked up the hospital part. Is the dentist a medicaid provider? If not, that could be the hang up. Your dentist AND hospital have to be a medicaid provider, and they should be submitting all the preauthorization paperwork and getting back to you, not the other way around. Our dentist was listed as a medicaid provider, but was not taking new medicaid patients, so we still paid our dental copay, but the hospitalization was covered 100%.
 

·
Registered
Joined
·
1,589 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>superstella</strong> <a href="/community/forum/post/7901646"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;"><br>
Also, is there any way you can just go ahead and have it done at the hospital and then sort the bill out later? You usually don't pay up front for hospital procedures, so maybe you could have them do it at the hospital and then resume the fight with the insurance companies after the fact?<br><br>
Hope you get it sorted out soon.</div>
</td>
</tr></table></div>
<br>
She would still have to pay the dentist upfront,as a dentist would have to be the one doing the work. And that would require scheduling an appt,which would have to be paid in advance(to the hospital,for using the facilities,and anesthesia costs,etc) Can't just walk in the ER and tell them to fix the teeth,unfortunately. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 

·
Registered
Joined
·
3,701 Posts
Discussion Starter #6
The dental insurance is covering the dentist and dental stuff done in the hospital. They even cover the sedation meds since she is under three, but they will not pay any of the hospital fees. Medicaid can pick the rest up, but they have to approve it first. This can take months. I am calling them in the morning. I don't know what I'm going to say to them, but something has to be done. She jsut woke up crying again. She crys and says owie. I asked where her owies were and she points to her top teeth. It's a bad pic, but here is one of her teeth. <a href="http://tinypic.com/view.php?pic=4gnifpx" target="_blank">http://tinypic.com/view.php?pic=4gnifpx</a>
 

·
Registered
Joined
·
2,149 Posts
Poor baby<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> Maybe I am naive, but why does it take medicaid so long to get pre-approval? We got it in a few days, as we took a cancellation slot--good thing, too, since it was ds's last month eligible for medicaid. Any reason why the dentist is not handling the preauthorization for you through the hospital? I guess I am just not understanding the preauthorization hang up, as we never had trouble with any of that for medicaid.
 

·
Banned
Joined
·
5,868 Posts
How infuriating.<br><br>
You need to be the squeaky wheel. Also the dentist needs to get involved. He needs to call Medicaid and write letters until this is adressed. If I were you I would be calling and writing letters EVERY freaking day.<br><br><br>
Not long ago, a mother lost her son in DC after a similar situation. She was unable to get her son's cavities treated due to Medicaid issues, and the boy got an infection that went to his brain and killed him <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/mecry.gif" style="border:0px solid;" title="crying"><br><br>
I would contact my local representative, if I had to, remind him of that story, and ask if he can help. That just isn't right. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad">
 

·
Registered
Joined
·
14,239 Posts
I am going thru the same thing with both my kids they need work desperatly and ds has already had the top 4 teeth pulled due to decay <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> It was done in office with numbing shot only and wasnt as bad as I thought it would be but it sure wasnt good either. They couldnt do nitrus oxide with him because him being 26 months old there is no way to keep the canula up his nose during the proceedure and for nitrus to work it must stay on the whole time because it wears off super fast once they are no longer breathing it.<br><br>
Our medical insurance will not cover the cost of the hospital and they wont schedual the work without payment up front because of it. We are talking nearly a 1000 up front there is just no way we can do that. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> I feel blessed that neither of them are in pain yet but it is only a matter of time.
 

·
Registered
Joined
·
1,473 Posts
I agree on going in and working it out with Medicaid later, if that's at all possible. Also, you mentioned she had to swallow medicine, has anyone offered you nitrous oxide as an alternative? The dentist in the office I worked at used it on children all the time. It's quick, has few side effects and doesn't need to be swallowed or injected. Hope your little one gets some relief soon!
 

·
Registered
Joined
·
1,589 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>seren</strong> <a href="/community/forum/post/7902099"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">The dental insurance is covering the dentist and dental stuff done in the hospital. They even cover the sedation meds since she is under three, but they will not pay any of the hospital fees.</div>
</td>
</tr></table></div>
The hospital wants you to pre-pay the fees I am guessing,right?<br>
Poor thing. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/greensad.gif" style="border:0px solid;" title="greensad"> I have 2 with bad teeth,both have had work done under sedation,one in the hospital,so I know what you're going thru. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">
 

·
Registered
Joined
·
2,609 Posts
I don't have any good advice, but I wanted to give your sweet baby a <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug"> and one for mama too. <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/hug.gif" style="border:0px solid;" title="hug">
 

·
Registered
Joined
·
168 Posts
I just want to say I'm sorry and I've been there. DD2 had 8 (or was it 9?) fillings, 2 caps and a baby root canal done under general anesthesia in October. Luckily she didn't have any infections yet because we were in the process of trying to fix her teeth for almost a YEAR! We saw several dentists before we found one we were comfortable with. Scheduled the procedure for a couple months in advance. <i>Then</i> we found out our medical ins wouldn't cover the facility and anesthesia charges - tried to appeal to no avail. Finally, we ended up taking her to a hospital that has a dental program where dentists are going through additional training to become pediatric dentists. We still had to pay for the facility and anesthesia up front, but it was about $1500 rather than the $6000 that the other children's hospital wanted. We still didn't have $1500, but pulled out the credit card because it was either that or wait for it to get worse.<br><br>
Good luck and I hope it all works out for you soon.
 

·
Registered
Joined
·
684 Posts
one of my friends work at a childrens hospital in their dental wing and they will help cover what the insurance won't since it is a childrens hospital have you tried that rout yet? Just a thought
 

·
Registered
Joined
·
3,701 Posts
Discussion Starter #16
My computer is on the fritz, so I will be updateding as often as I can get to my moms or the library.<br><br>
Yesterday i called everywhere I could think of. THe Children's hospital only does dental work for children with handicaps. I called several dentists in the bigger cities around us. Finally I found one who actually cared when I told them what was going on. At first she said they weren't seeing new patients until June, I told her we couldn't wait that long. I told her everything that had happened. She asked if Mady was in pain and I told her that the Tylenol with Hydrocodone wasn't working anymore and they gave her Lortab. Her responce *OH MY GOD!!!!* We have an appointment Tuesday morning. It's a little over an hour away, but so worth it!!!! Dh was able to take a floating holiday so I will hopefully be able to update when we get back from the appointment.
 

·
Registered
Joined
·
1,589 Posts
<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">
<div>Originally Posted by <strong>seren</strong> <a href="/community/forum/post/7914830"><img alt="View Post" class="inlineimg" src="/community/img/forum/go_quote.gif" style="border:0px solid;"></a></div>
<div style="font-style:italic;">Finally I found one who actually cared when I told them what was going on. At first she said they weren't seeing new patients until June, I told her we couldn't wait that long. I told her everything that had happened. She asked if Mady was in pain and I told her that the Tylenol with Hydrocodone wasn't working anymore and they gave her Lortab. Her responce *OH MY GOD!!!!* We have an appointment Tuesday morning. It's a little over an hour away, but so worth it!!!! Dh was able to take a floating holiday so I will hopefully be able to update when we get back from the appointment.</div>
</td>
</tr></table></div>
<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/clap.gif" style="border:0px solid;" title="clap"> Will she do it in the office,or do you still have to wait for the insurance? I'm a little confused,cause I thought the insurance covered the dentist,but you were having trouble getting authorization for the hospital? <img alt="" class="inlineimg" src="/img/vbsmilies/smilies/dizzy.gif" style="border:0px solid;" title="Dizzy">:<br><br>
OMG was also my reaction when I read they gave your dd lortab!! Sheesh!
 

·
Registered
Joined
·
4,393 Posts
I'm so glad that you found someone to help you! My DD had cavities in her molars and we had them fixed right away because they started to hurt. I can understand your desire to find someone to take care of it right away - seeing your child with painful teeth is very heartbreaking! My daughter had oral sedation in the office with my DH holding her in his lap and she has no memory of the visits at all. She was such a happier kid when everything was done - and my stress level plummeted!<br><br>
Good luck and keep us updated! We will keep you all in our thoughts until then!
 

·
Registered
Joined
·
3,701 Posts
Discussion Starter #20
I'm at the library, so really long story short. The dentist we saw today was wonderful. Sadly, he didn't think he could help us much. We have to wait for Medicaid to approve the procedure. That means waiting for them to schedule a second opinion, getting the results, doing a review board, it could take months. He said he would call a lady he knows in the Central office and see if he could get it expedited. He told me to call the dentist we saw last week and see if they have already submitted the paperwork. If so he would call that lady and ask if he could be the second opinion. He gave me his cell phone number. Within ten minutes of leaving his office I called to tell him that yes the other dentist had already submitted the paperwork. He said he would call that lady and see if he could be the second opinion and would call me back. He called back in less than 10 minutes. When he called the program director was there and he talked to him. Not only did they let him be the second opinion, they have approved ALL OF IT!!! No waiting whatsoever! The central office is calling Mady's other dentist today with the preauthorization number so they can schedule the surgery ASAP. We have benn SO blessed!!!!!
 
1 - 20 of 30 Posts
Top