Referral to a Pediatric Dentist
September 10, 2014 10:26 AM Subscribe
Our dental insurance only covers a pediatric dentist if it comes by way of a referral from another dentist. Our current dental office, which we actually like quite a bit normally, says that they won't provide a referral for my daughter, as "things seem to be going okay here without the referral." My wife has tried to have this conversation with their office twice now.
It might be that I don't understand well enough how this works, but is there a good reason for them to not provide a referral? My daughter has some work coming up on her teeth, and she has expressed to us that our current dentist's office makes her feel nervous (it is pretty sterile and appeals to grown ups, I suppose), and that she would feel more comfortable at a kids' dentist. Is there something that I'm missing in this conversation that I should be understanding better? Is it bad that they won't provide a referral, or are we out of place for asking? This is in California.
It might be that I don't understand well enough how this works, but is there a good reason for them to not provide a referral? My daughter has some work coming up on her teeth, and she has expressed to us that our current dentist's office makes her feel nervous (it is pretty sterile and appeals to grown ups, I suppose), and that she would feel more comfortable at a kids' dentist. Is there something that I'm missing in this conversation that I should be understanding better? Is it bad that they won't provide a referral, or are we out of place for asking? This is in California.
My wife has tried to have this conversation with their office twice now.
I think it's time to contact the dentist directly if that's possible. This is a reasonable thing to want and there should be no obvious reason (besides the loss of business) for them to not provide it. I was a kid who had a lot of dental work done and I was very happy to have this work done by a pediatric dentist and I just want to support your continued pressure on your dentist's office for this. Scorched earth tactic: she will be going to another dentist in any case, we'd prefer a referral to someone you know and trust.
posted by jessamyn at 10:31 AM on September 10, 2014 [4 favorites]
I think it's time to contact the dentist directly if that's possible. This is a reasonable thing to want and there should be no obvious reason (besides the loss of business) for them to not provide it. I was a kid who had a lot of dental work done and I was very happy to have this work done by a pediatric dentist and I just want to support your continued pressure on your dentist's office for this. Scorched earth tactic: she will be going to another dentist in any case, we'd prefer a referral to someone you know and trust.
posted by jessamyn at 10:31 AM on September 10, 2014 [4 favorites]
Call them back, say "things are not going fine. My daughter is uncomfortable at your practice and we won't take her to you again as a result. Can you refer us to a pediatric dentist for her or should we all as a family go look for a new dentist?" If they refer, great, if they don't, your dentist sucks and you need a new one.
posted by brainmouse at 10:32 AM on September 10, 2014 [23 favorites]
posted by brainmouse at 10:32 AM on September 10, 2014 [23 favorites]
Your dentist may be under pressure by the insurer to reduce such referrals, and may need to provide convincing documentation for the reason to do so as well.
posted by grouse at 10:38 AM on September 10, 2014 [6 favorites]
posted by grouse at 10:38 AM on September 10, 2014 [6 favorites]
I think the solution of simply saying, "provide a referral or we'll get one from another dentist" is the simplest and best. It provides the dentist with the choice of all but one of your family as patients (if they provide the referral) or none of your family as patients (if they don't). However, if you don't want to go down that route for some reason...
is there a good reason for them to not provide a referral?
Yes, this is solely a financial decision. Your dentist is directly and indirectly financially incentivized to keep patients under their care. They are directly incentivized because if they refer you, they lose a patient. They are indirectly incentivized because their insurance company could potentially start reducing their reimbursement and/or cutting them from the plan if they provide too many referrals. Unnecessary referrals increase health care costs, so there is also a ethical/pragmatic consideration from the perspective of the dentist (if you take scarce health care dollars for your daughter, someone else won't be able to).
The solution to this is to provide them with the information they don't have - how your daughter isn't comfortable with the dentist's care. You need to qualify "she would feel more comfortable" because that's a desire, not a need. Does she evidence any behavior at home that indicates she is actually afraid of the dentist? If so, that's what can change the dentist's mind.
posted by saeculorum at 10:54 AM on September 10, 2014 [3 favorites]
is there a good reason for them to not provide a referral?
Yes, this is solely a financial decision. Your dentist is directly and indirectly financially incentivized to keep patients under their care. They are directly incentivized because if they refer you, they lose a patient. They are indirectly incentivized because their insurance company could potentially start reducing their reimbursement and/or cutting them from the plan if they provide too many referrals. Unnecessary referrals increase health care costs, so there is also a ethical/pragmatic consideration from the perspective of the dentist (if you take scarce health care dollars for your daughter, someone else won't be able to).
The solution to this is to provide them with the information they don't have - how your daughter isn't comfortable with the dentist's care. You need to qualify "she would feel more comfortable" because that's a desire, not a need. Does she evidence any behavior at home that indicates she is actually afraid of the dentist? If so, that's what can change the dentist's mind.
posted by saeculorum at 10:54 AM on September 10, 2014 [3 favorites]
Yes, it "is BAD that they won't provide the referral." Not to mention, oh so incredibly $elf-$serving for their dental practice. Obviously, your dentist is not looking out for your daughter's actual best interests here (or, on preview, what @saeculorum just said). Good thing you are.
I wonder-- if you were to call up one of the local Pediatric Dentists' office (check the dentists' bios and make sure they are actually Fellowship Trained in Pediatric Dentistry versus a general dentist who markets to kids) and explain your problem to them (current dentist is actively trying to prevent us from leaving them despite our repeated requests), and see if they might have a practical solution - (like they initiate a request to have your daughter's dental records sent over).
posted by hush at 10:54 AM on September 10, 2014 [1 favorite]
I wonder-- if you were to call up one of the local Pediatric Dentists' office (check the dentists' bios and make sure they are actually Fellowship Trained in Pediatric Dentistry versus a general dentist who markets to kids) and explain your problem to them (current dentist is actively trying to prevent us from leaving them despite our repeated requests), and see if they might have a practical solution - (like they initiate a request to have your daughter's dental records sent over).
posted by hush at 10:54 AM on September 10, 2014 [1 favorite]
Agree with grouse that there may just possibly be insurance factors behind the scenes here; for that reason you may need to do this in writing if you haven't already. Write a letter to the dentist that lays out that (1) your daughter is distressed by the adult practice and that her effective treatment will therefore require a pediatric practice; and (2) that you will be expecting their response with a written referral to X pediatric dentist (I would do your own research here and find one that your insurance will cover and specify this in the letter) by no later than [date].
posted by fingersandtoes at 10:56 AM on September 10, 2014 [3 favorites]
posted by fingersandtoes at 10:56 AM on September 10, 2014 [3 favorites]
Are you sure the referral has to come from another dentist? I recently had a wisdom tooth pulled, and thougt I needed a referral, which required an exam, which cost 130.00. Well all I really needed was a referral from my primary care doctor...
posted by Gungho at 11:48 AM on September 10, 2014 [1 favorite]
posted by Gungho at 11:48 AM on September 10, 2014 [1 favorite]
Have you considered looking for another non-pediatric dentist? A family practice might be a better fit for her than a larger, more professional shiny office. My caters-to-adults dentist, for example, has pictures of Spiderman and patients' pets all over his office... because he really likes Spiderman and cats.
Otherwise I am with brainmouse - "refer us to a pediatric or maybe we'll all go somewhere she's more comfortable."
posted by maryr at 12:30 PM on September 10, 2014
Otherwise I am with brainmouse - "refer us to a pediatric or maybe we'll all go somewhere she's more comfortable."
posted by maryr at 12:30 PM on September 10, 2014
Have you told the current dentist that she feels nervous there? If that's the reason, do they know the reason? Just checking...
posted by amtho at 12:47 PM on September 10, 2014
posted by amtho at 12:47 PM on September 10, 2014
Response by poster: Thanks, everyone. This was great feedback and is certainly going to inform my discussion with them. Talking with my wife, we will play a bit of hardball. We'll walk if they can't accommodate the request. Not as a bargaining tactic so much as a general concern about them not taking our request seriously with our best interest in mind. If they say no for primarily financial reasons, I don't really feel as if they have our best interest in mind when they go digging around in our mouths, either, which makes me a bit uneasy.
posted by SpacemanStix at 1:47 PM on September 10, 2014 [5 favorites]
posted by SpacemanStix at 1:47 PM on September 10, 2014 [5 favorites]
This thread is closed to new comments.
Depends on what you mean by "good." From their side of things, the reason seems to be "we want to keep the money and not send it elsewhere." If you're certain your daughter would be better off at a pediatric dentist's office, I'd suggest putting your third (and final) demand for a referral in terms of "give us a referral or we will find a new dentist for all of us."
posted by craven_morhead at 10:30 AM on September 10, 2014 [14 favorites]