How to handle a behavioral management charge at your practice

A charge for behavioral management of her child at a dental practice in Washington has one mom claiming special needs discrimination, but a practice management professional doesn't believe that is the case.

Teresa Duncan, the president of Odyssey Management, told DrBicuspid that she doesn't find the charge discriminatory if the child's visit took longer than expected. However, patients and caregivers should be informed of the charge beforehand.

"Patients should always be aware of the charges for their visit,” Duncan said. “A patient discovering a charge after the visit is disappointing and can understandably result in loss of trust."

In a TikTok video, a mom, who goes by the handle @tw00dyyy, explained that the bill for her child's dental visit included a $33.70 behavioral management charge.

The mom, a dental assistant who had never seen the insurance code for this charge in the past, asked the office about it. The office reportedly told her not to worry because insurance would cover it. Her children have private insurance and qualify for state insurance, according to the video.

The woman wasn't happy with that response. She wondered what constituted the charge since her child did not bite, hit, spit, or fight while at the practice. A representative at the office allegedly told her the charge is submitted because it will be covered.

Furthermore, the woman explained that taxpayers may be paying more than $1.6 million on these charges for kids who receive state insurance that may not be necessary.

Duncan explained that the behavioral management code is meant for patients who take more time and planning to treat.

“I don't agree that it's discriminatory if the appointment takes longer," she said. "Medical billing codes account for time and complexity. This could include reviewing records and coordinating with other care providers."

However, Duncan warned that patients should always be made aware of the charge even if insurance will pay for it.

"Offices that bill 'just because it will be covered' are asking for audits, fines, and even bad publicity -- as seen in these situations," Duncan said.