I messed up with son's dental care

[ForeverDad]

I could just kick myself!

Back history... .I  am son's Legal Guardian since 2011.  Naturally I get stuck with all his insurance, bills, etc.  So I usually take him to his dental visits.  Well, Last visit I was in a programming boot camp to learn current programming language skills.  When I lost my job a couple years ago (data sent to another division and site closed) I was a senior programmer/analyst, but in a legacy Microsoft application.  Translation, no local jobs using that anymore, I'd have to move to another state but my kid doesn't want to move and I won't step out and have my ex take over.

So my ex took him and I heard it went fine, there was some mention of a "watch" for next time but I was so preoccupied with classwork I never focused on it.   Well, this visit they said the watched area was now a cavity and the tooth beside it was showing damage too.  That's when my Spidey Sense kicked in and I started making noise.  "Hey, if decay was detected last visit, why wasn't an ICON treatment applied to stop it in its tracks?  He's had it before, would it not have worked?"  I could tell the dentist was so sorry he hadn't made clear that ICON could have helped several months ago to avoid drilling the next time.  (I can only assume he has few parents willing to pay the extra cost to use this technology.)  But what's done is done and so one tooth was drilled and filled while the other with less decay was ICONed.

What is ICON?  ICON (by DMG America) provides the dentist with "a resin infiltration technology that fills, reinforces, and stabilizes demineralized enamel for the purpose of arresting the progression of incipient carious lesions and removing cariogenic white spots." Resin infiltration is a new treatment that has been gaining popularity as an alternative treatment that ends the “wait and see” approach to caries management, without having to “drill and fill.”

Translated, the dentist applies an acid to eat away the minimally damaged area of tooth and then applies a resin to soak in to strengthen and seal the cleansed area.  Tada!  No drilling!

It is actually less expensive than drilling but (at least in the past) dental insurance didn't cover it and so its cost to the family was more expensive than covered drilling/fillings.  I see that that the ADA announced 12/07/2012 it is now covered by a 2013 CDT Code classification.  I'll ask my dental insurance and/or the dental practice whether it is now covered by dental insurance.  I was charged the full price and so I wonder if the dentist knows it now has a recognized code or if insurance still ignores it.

I can't change the past slip up, but I'm still aggravated that I missed an opportunity to help my teenager limit the dental repairs that will now require fillings replaced every decade or so.

I assured the most excellent dentist I hold no hard feelings and neither had I mentioned anything about it to my ex.

[Turkish]

It sounds like the dentist didn't truly communicate the treatment options,  yes?

The summer of 2013 when my ex went off the rails,  our son was 3. We hadn't taken him to a dentist. When we did,  the first dentist suggested a root canal.  Fall was open enrollment and I switched to a better plan and researched to get a better dentist, a UCSF graduate. He said that the root canal was unnecessary,  but still did both back molar fillings, so I think of him as Jaws from the old James Bond films. 

Life happens,  and as much as we like to think we can cover everything, we often can't.  He won't be damaged permanently,  right?  And you are busy trying to improve your lives. 

[ForeverDad]

I'm peeved with myself for letting the entire matter slip by, the kid for not keeping up with regular flossing, the dentist... .well he's a great dentist, trained at the local children's hospital, was the first in the area to use ICON, so I can't blame him, not when most parents choose the cheaper-with-insurance drilling.

This all boiled up within me a couple nights ago so I'm waiting for a weekday to call my insurance to confirm whether they honor the ADA's billing code D2990 for the resin infiltration treatment.  Then I'll contact the dental practice to share with them all I've learned from my research.  Years ago, around 2011, he had said no billing code had been issued.  It's been official for several years now, so once I determine my insurance's stance I need to confirm whether he is aware of it.

I must admit to hoping this alerts other parents that tooth decay, if detected early enough and is sited in certain parts of the tooth, can be permanently arrested without the need for Novocaine, drilling and filling every decade or so.

[Turkish]

I think that what might be what they did to our son after he got drilled and filled. Resin coating. 

[JNChell]

Just a blip. Go easy on yourself. No big deal. I wish that you could see what you do from the receiving end. Give yourself this break.

[ForeverDad]

Yes, I overthink things.  I called my dental insurance carrier, supposed to be one of the better ones, and though they confirmed they did have the code D2990 it was doubtful my plan included it.  I was like, "What?  This newer treatment is less expensive than the old drilling costs — my dentist charges more for drilling than this treatment — it's a no-brainer to automatically include it!"

So I called my former employer, I'm grandfathered in, and they recommended I send an email asking for that option be added to our dental plan.  Next year.  Sounds like another obvious task to drag kicking and screaming into the 21st century.

[whirlpoollife]

Agreed with JNChell don't beat your self up over this.  Your questioning to the insurance company will bring the newer procedure to their next meeting, it won't go unnoticed.
I don't have dental insurance.  About couple years ago I had my son , now 20 go in for his dental visit . I paid for the check up.  He had a mouthful of cavities so follow up was needed to get them filled.
Son was living somewhat on his own at friends house, my house and his dad's house,  so my parenting was limited to get him to go. But finally got  him in.  I wasn't there at that appointment but later to pay, with discount for cash , and aquaintance through kids/school . I find out the dentist only filled half. Didn't want to do all at once on son.  I didn't expect that , I thought all would be filled at once. I was mad that I didn't tell dentist ahead of time to do that as I know my son and he will have every excuse to not go back and he hasn't .
So FD I know how you feel on messing up. It sucks.
Move foward to the next 6 month check up with quick life skills talk to S on importance of it. And that's all we can do.

[ForeverDad]

Well, I received a response from my employer's dental health contacts.  They consider this method "emerging technology" and don't cover it.  The response stated "silver diamine fluoride could be used to arrest that lesion – which is better and covered".  That is billing code D1354.  (SilverDF.org)  One article stated SDF requires a couple treatments.  The main downside is aesthetic: Silver diamine fluoride blackens the brownish decay on a tooth.  A variant formulation is NSF, nano-silver flouride.

[empath]

FD, my son is a senior software engineer at a well known company. You sound a lot like he does when he talks about his daughter's medical care. She was born very prematurely, and when I wanted to get the details of what was happening, I would ask him. He gave me numbers and info about her care. His wife didn't usually have such a detailed description; hers was more general and focused on the feelings and practical considerations.

The point is...  they are a fairly "normal" couple, and each of them have different perspectives and things they pay attention to.

Insurance companies have their own standards about new technologies and when they begin to cover those.