Dentist charging a "behavioral fee" for ASD child?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP--Just to note, I asked why we were being charged a "behavioral fee," and where we had agreed to do so. After asking several questions about this extra charge, and after other parents in the office also began to take notice, I was told that we no longer had to pay the fee. But please be forewarned about this practice.

I mean, to be fair you admitted in your post that your child’s behaviors were a lot. And required extra time and accommodations, which Dr shin provided? (And did YOU give the office advanced notice that this type of extra time and accommodation would be necessary for your child?—and did they “agree” to it?) Just trying to apply your rationale for NOT paying to their rationale for charging to begin with.

The fact that it took extra time and accommodation to successfully complete this appointment was not in dispute by you. But how can they warn you in advance about a special behavioral fee (which probably took extra staff, and time they weren’t prepared for given the regular appointment time allotted) if they don’t have any clue until you get there that there are any special circumstances??

Sounds to me like they were trying to go forward with the appointment as best as possible while also being compensated fairly …and yet when you pitched a fit about it, they removed the fee just to avoid the hassle of you.
And likely wanted to just have you leave in peace.
But you were so ungrateful and resentful that you decided to come on here and trash them online anyway. Wow.

Nothing she said or did seems out of line to me. I’m sorry that you are faced with some challenges in this department, but no one owes you services.

No PP - you don’t get to add a surprise autism fee because you felt the child was too difficult. And OP wouldn’t be here if the dentist had acted in a compassionate and ethical manner. Instead the dentist fired OP’s kid then tried to charge extra to boot. If the dentist had said “Hey, we are not really equipped for this - here’s the name of another dentist” that would have been fine albeit annoying.

The issue isn't the diagnosis. The issue is the time. If it took the same time as two or three appointments, then they are losing out on that money and it takes money to run the office and pay the staff.

No, that is illegal, PP. A provider cannot charge you for taking more of their time unless you signed something before receiving services agreeing to pay more if the service takes more than the usual allotted time - and in that case, that time has to be mentioned in the document.

You are dead wrong on the law. So stop weighing in.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Honestly, that sounds reasonable as you are paying for their time and if you needed frequent breaks and other things, understand its a business and they have to pay staff and that means they cannot schedule another patient. If an regular appointment takes 30 minutes and yours took an hour, they need to account for the extra time.

No, because the fee was not agreed to in advance. [/b]You can't charge someone post-hoc. That is illegal.[b]

The dentist was well within her rights to refuse to see the patient again. But she cannot suddenly invent a fee after realizing that the client is difficult!

Thank you, OP, for the heads-up about this practice. We don't be going there.

[Anonymous]

My ASD teen loves Dr. Lewis at EJL dental. Their office isn't perfect but they have been doing this for years and are very committed to serving special needs kids and adults.

When my daughter had a bad experience (due to disruptive NT kids) Dr. Lewis offered her specific accommodations and assured her that she could continue seeing her into adulthood which provided a lot of relief to my daughter who hates to meet new providers.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That’s an ADA violation discriminating against a disability. The American Dental Assoc also acknowledges it’s improper to discriminate on the basis of disability.

It’s not an ADA violation to decline to treat someone you don’t believe you’re qualified to treat.

This is accurate.

The cleaning was completed within the normal appointment window, so it clearly was not the case here that she wasn’t qualified. the dentist just didn’t WANT to give the accomodations, which is illegal.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Did you inform the staff of your child's issues and needs ahead of time?

Yes. I provided all the information about DC's diagnosis, as well as specific accommodations that might be helpful (i.e. turn off television, solo room, nothing tied around neck) in advance. They didn't seem to have read any of the notes when we came in.

This office clearly didn’t handle it well.
But This is where you need to do better next time also, OP.

Bring a hard copy of these notes.
Hand one to he receptionist (for the file) and one to be given to the hygienist and doctor. Tell the receptionist that you would like confirmation that all who will be working directly with your child have read the summary before you go back to the exam room/dental chair.
You need to be an assertive proactive advocate for your child’s needs. No more passively hoping someone will read what you emailed and give it to “the right” people to read also (they won’t—they’re super busy).
Then you need to ask if they are fine with these accommodations and if there are any questions or anything you need to know about fees prior to going back to the room/chair.
They didn’t tell you.
But they maybe didn’t know to ask.

No the office needs to read notes ahead of time or do some sort of screening if they are going to charge a fee. What if OP shows up with hard copies of the notes and they say never mind we can’t do your appointment. Now she has wasted hours of PTO plus her kid has missed school for no reason.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That’s an ADA violation discriminating against a disability. The American Dental Assoc also acknowledges it’s improper to discriminate on the basis of disability.

It’s not an ADA violation to decline to treat someone you don’t believe you’re qualified to treat.

This is accurate.

No one is disputing the dentist's right to refuse to see the patient again. No provider should be forced to treat a patient they don't want to treat. The dentist could have stopped the treatment mid-way, in all legality, actually - and then the regular fee would have been in question. I think it could be prorated or waived.

The dispute centers around demanding to be paid more after the fact, without prior agreement. That is not allowed.

This is why the office finally withdrew the extra charge - they knew they were doing something illegal. They just wanted to try and see if OP paid. I hope OP reports them to whatever board dentists have.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That’s an ADA violation discriminating against a disability. The American Dental Assoc also acknowledges it’s improper to discriminate on the basis of disability.

It’s not an ADA violation to decline to treat someone you don’t believe you’re qualified to treat.

This is accurate.

The cleaning was completed within the normal appointment window, so it clearly was not the case here that she wasn’t qualified. the dentist just didn’t WANT to give the accomodations, which is illegal.

The dentist gave accommodations. But, if you want extra time you need to pay for it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That’s an ADA violation discriminating against a disability. The American Dental Assoc also acknowledges it’s improper to discriminate on the basis of disability.

It’s not an ADA violation to decline to treat someone you don’t believe you’re qualified to treat.

This is accurate.

The cleaning was completed within the normal appointment window, so it clearly was not the case here that she wasn’t qualified. the dentist just didn’t WANT to give the accomodations, which is illegal.

The dentist gave accommodations. But, if you want extra time you need to pay for it.

1. OP said it wasn’t extra time
2. Dentists don’t generally charge by the hour; so to suddenly charge an extra fee ex post because the child is “too high on the spectrum” sounds awfully suspect
3. Even if the dentist was on sound legal ground she behaved heartlessly and unprofessionally, and deserves the bad press she’s getting here.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That’s an ADA violation discriminating against a disability. The American Dental Assoc also acknowledges it’s improper to discriminate on the basis of disability.

It’s not an ADA violation to decline to treat someone you don’t believe you’re qualified to treat.

This is accurate.

The cleaning was completed within the normal appointment window, so it clearly was not the case here that she wasn’t qualified. the dentist just didn’t WANT to give the accomodations, which is illegal.

special appointment window (longer)

stop making sh*t up.

[Anonymous]

They probably charged you a fee because the dentist had to do the cleaning instead of the hygienist since your kid had too many problems. A dentists time will cost more than a hygienist. They probably said you don’t need to come back because you complained about not paying the doctor for their time.

[Anonymous]

Anonymous wrote:If it takes extra effort for the dentist to perform the procedure, then they can charge you for the extra service.

But I imagine this is something that isn’t negotiated for with a dental insurance provider. If I show up to a dentist or any provider I expect them to follow the rates they negotiated with my insurance company. If they have additional fees those need to be advertised ahead of time, which is actually standard (e.g. I’ve seen practices advertise things like fees for no shows, after hours visits, and filling out forms). Nowhere have I ever see a “behavior fee” especially when you’re treating a child patient (even neurotypical kids could have trouble with certain procedures, sounds, tastes, etc.).

I would never go to a practice that advertised such a fee and further you can’t just make up fees after the fact when there was no express or implied agreement to pay it. Otherwise what is to stop any establishment (doctor, restaurant, grocery store, etc.) from making up after the fact fees with amounts pulled out of thin air.

[Anonymous]

How long was your child in the chair for op?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If it takes extra effort for the dentist to perform the procedure, then they can charge you for the extra service.

But this did not take extra time, so why are you posting this? Just to bash a special needs family?

OP is bashing a dentist who is charging extra as her child took significantly more time than what is allotted. It's not fair to expect them to work for free.

That is not what happened. And the dentist started the appointment late because she was chatting with another parent. Did she charge a “chatting with a parent” fee to that patient? Or is it only disabled kids who get the fee for taking up extra time (which per OP didn’t even happen).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP--Just to note, I asked why we were being charged a "behavioral fee," and where we had agreed to do so. After asking several questions about this extra charge, and after other parents in the office also began to take notice, I was told that we no longer had to pay the fee. But please be forewarned about this practice.

NP. The whole thing sounded very tense and stressful for everyone involved, for your DC, you, and the dentists and techs. Maybe you have become accustomed to the stress (tbh, I have not, after so many years, I'm a bit of a wreck now) but the dentists and techs aren't.

You didn't say how old your DC is or how previous other dentist appointments have gone. What is tolerated in young children is less tolerated in older, larger children. Good luck at your next dentist.

Healthcare providers need to be able to work with people with disabilities. Full stop.

I know this is not the point of this post. But you are wrong. Special needs are a spectrum and to say that every single provider should be able to handle every single person with special needs is a crazy idea. Depending on the type and level of severity, special training and skills that don’t exist in the general population might be necessary.

They cannot just dump a patient on the basis of a disability with no attempt to accommodate. Based on what OP said, it sounds like the child could be accomodated (completed the checkup successfully) but the dentist just didn’t want to.

The dentist did accommodate them but it took additional time and OP wasn't willing to pay for that additional time. She is wrong.

IT DID NOT TAKE EXTRA TIME. That has been pointed out multiple times. Why did you insist otherwise?

I have never seen any doctor give a start and end time. I just don't believe it. The fact that the kid got out of the chair several times means by definition it took longer than it needed to. And how long did it take to pick out the toothpaste. Practitioners have a right to ask about medical history - I agree that the way they asked was not optimal.

This is totally not true. I’ve gotten automated email reminders showing an appointment time slot or have had providers tell me to expect an appointment to take “approximately x time.” In fact I have an orthodontist appointment tomorrow that is supposed to take 45-60 minutes. I generally like knowing ahead of time how long an appointment is expected to last so I can plan when to be back at work.

[Anonymous]

Anonymous wrote:How long was your child in the chair for op?

OP again here. Thank you to all the other parents who expressed their support for us and dismay over the situation. I still feel upset about what happened but your supportive words make it much better, and I hope you all never have to face this situation.

Since the length of time that my child was in the dental chair has become such an item of interest, I would estimate that the visit took 35-40 minutes.