Extra dental care charge for boy with autism angers parent

By Melissa Busch, DrBicuspid.com assistant editor

March 16, 2020 -- A family in Illinois was shocked when it was hit with a $75 behavior management fee for the dental care of its 10-year-old son who has autism. The fee, which is not covered by the family's insurance, has left the boy's dad irate and refusing to pay it, according to news reports.

Michael Johnson was reportedly surprised and outraged when he received the bill with the extra charge for his son Wesley's routine dental visit. The dentist, who hasn't been identified but practices in Chicago, sent the bill to Johnson in March.

Feeling like the charge is "one more cost of having a child with special needs," Johnson promises to fight the fee. Children with developmental disorders, such as autism, have communication, sensory, and social difficulties that can make dental care difficult.

However, he may have an uphill battle.

"While I don't know the office's point of view regarding the fee explanation, it seems that the code application was proper," said dental insurance expert Teresa Duncan of Odyssey Management.

The billing code for this type of fee is available to any dentist who ends up spending more than the time allotted with a patient or if the patient requires additional staff. Unfortunately, many insurance companies don't reimburse this.

Johnson said that he has never told about the fee and that they hadn't received one in the past, though the boy, who has sensory issues and doesn't like being on his back, has been seeing this pediatric dentist for years. When he questioned the practice about the fee, the office said it was charged because Wesley's visit ran longer than the time it had allotted for the appointment.

Wesley and his dad attended the visit with his therapist, and, though it lasted a little longer, it was a pretty routine visit, Johnson said.

Give patients a heads up

There are ways to avoid this kind of situation.

Patients deserve to be told the expected fees for treatment, and, ideally, the cost should be explained to the patient or the patient's family prior to a visit or at least before treatment, Duncan said.

"This is not a surprise conversation that anyone would like," she said.


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