Children with special needs—from sensory to behavioral issues—are being charged an extra fee at the dentist.
A mom learned this on a recent visit to the dentist with her child. And she is crying foul.
“Listen to this if y’all don’t think insurance is a fraud,” said TikTok user @tw00dyyy (who we’ll refer to as T) in a trending video.
What is a ‘behavioral management’ fee?
In the clip, T explained that her kids qualify for the Washington State dental insurance. They also have private insurance.
During their visit today she noticed that her son’s bill included a code charging $33.70 for “behavioral management.” Now, T is a dental assistant with more than a decade of experienced and had never seen that code. So, she called up the office.
The worker on the phone initially gave her the run around, and assured her that the insurance would cover the charge.
“No, I want you to tell me what it is,” T said, standing firm.
“Behavioral management, that’s harsh words. Like, my son didn’t bite, didn’t hit, didn’t spit, didn’t fight you. What did you guys manage? What behaviors did you manage when we were there. Did I miss something? I’m really confused,” T said.
‘Because we can’
The woman told her that the state is the only insurance that offers that code, “so we charge it because we can,” the woman admitted.
T looked absolutely flabbergasted by her response.
“Imagine how many daily $33.70 codes the state gets for insurance and they just pay it,” T said.
While she knew people would come at her for being upset over a charge that she doesn’t have to cover, T pointed out that it’s the principle of the matter.
“It’s the fact that it comes out of tax-paying money,” T said.
Still stunned by what she’d just learned, T went deeper into the issue and calculated how much money the state was spending on this random code each year.
Here’s her calculation:
- About 253,126 kids are born in Washington state each year
- 39% of kids in Washington are on the state dental insurance. So 253,126 times .39 brings the number to about 98,719 kids
- Assuming half of those kids go to the dentist, that’s 49,359 kids
- 49,359 kids times the $33.70 behavioral charge equals $1,663,417 spent a year
Now, T’s calculation isn’t perfect, but it does help paint a picture of how much this arbitrary fee is costing taxpayers. That money could be spent on other public resources.
People take issue with the fee
It seems this code, which is officially billing code D9920, isn’t exclusive to the Washington dental system.
One Chicago dad was taken aback when his son, who has autism and related sensory issues, was charged $75 for behavior management at the dentist’s office.
Yes, the appointment took a bit longer, but the fact that their health insurance wouldn’t cover it made the charge feel discriminatory, the dad told CBS News.
“To get the extra charge is just frustrating,” the dad said. “It feels like one more cost of having a child with special needs.
Dr. Ian Marion of the University of Illinois at Chicago School of Dentistry told CBS that it is best practice to discuss the charge with parents first.
A New Jersey pediatric dentist’s office has parents and guardians sign a document informing them of the potential add-on. Here’s what it reads:
“In our practice we occasionally find it necessary to invest beyond standard appointment time in the management of certain patients. This may be due to medical, emotional, or behavioral issues. We are more than willing to provide this service; however there is a charge of an additional behavior management fee of $50 per 15 minutes. This fee is related to the cost of committing the time and staff to achieve the optimum outcome for more sensitive patients.”
The State of New York went after a dentist who made $66,402 worth of improper claims under the behavioral management code.
Commenters react
“And yet necessary charges are denied left and right. You have fight to get them to accept some other charges!” a person pointed out.
“State probably pays very little for kid exam. So, offices try and get their money in ways the state allows. I bet with the charge the reimbursement still is some of the lowest they get,” another theorized.
“I reported something similar and my entire bill ended up getting written off,” a commenter shared.
@tw00dyyy What do yall think? #dentist #insurance #tiktoker #fyp #whatthehell #makeitmakesense #f #tik_tok ♬ original sound – t.babyxox
The Daily Dot reached out to T for comment via TikTok direct message and comment and to the Office of the Insurance Commissioner of Washington State via email.
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