Use of full sedation for dental surgery in children with autism...?

My 11 year old has autism and is totally non compliant with the dentist beyond a basic cleaning. He has some issues that need to addressed and the only way that will happen is in a pediatric OR under full sedation. Our dentist is wonderful, but we know our insurance company will turn down the full sedation (they only cover it if children under the age of 5). We are planning to appeal as there is no other way to do the needed work. I had been told at one time that since our child has diagnosed special needs that would make working on him in a tradtional way impossible, the insurance company must cover the costs. If anyone has any idea on where to look or a link to a site that discusses this topic, I would appreciate it. We live in MD, in case it is a state by state issue, Thanks so much!

Use of full sedation for dental surgery in children with autism...?
I've been in the same boat. My son is autistic Dental wouldn't cover anything performed at a hospital and health wouldn't cover anything dental. We were looking at about $6000 to fill 3 cavities - all out of pocket. It took getting the dentist to write a letter of necessity for services to both companies and it took many calls on my part. The companies were most uncooperative. I kept questioning why they were discriminating against my son. I guess that worked - they didn't like me using the "D" word and soon agreed to pay between both companies about 80%. It sucked and took a long time and they fought it tooth and nail. I'm with a different employer now and under a different plan. I wouldn't take the previous companies coverage again if it was free because of their attitudes toward the disabled and their needs. They have no idea how much things like this negatively impact their image. Weasels....
Reply:I don't know for sure if this would work, but could it be coordinated through his pediatrician / specialists as a medical needs issue that would be covered under insurance?





I know that at least in SC most autistism specialists / therapies are not covered under insurance, but maybe due to other medical needs it could be covered under medical insurance rather than dental.





For instance, there was a big story here a few months ago where a young child died due to a tooth infection spreading to his brain. Parents didn't have dental insurance so it went uncorrected and he ended up in the hospital having several surgeries, etc.





I pray that this isn't the case with your child, but maybe it can be done in conjunction with both doctors.





Best wishes!
Reply:My DD has autism and cerebral palsy. I know that our health plan will cover OR sedation for the CP...but you're right, they sort of balk at "mental" issues. I would just try it on appeal. Have both a pediatrician and the dentist (you'll need a dentist, preferrably pediatric, that has OR privileges) write letters of medical necessity.





Have you tried simply using nitrous oxide? That helped my DD at her last dental visit.





Also, a ped dentist typically uses a "papoose board". Perhaps you could try that in addition to nitrous oxide. It's a very archaic thing, and my DD hasn't had it yet, but she had a similar one for a nuclear medical scan and because she's a sensory seeker, she actually LIKED it - the constant proprioceptive pressure.





Another option is contacting a dental school to see if they have cheaper services - the students have to learn somehow! They may be able to do "twilight" sedation.





I wish you the best - I know what a pain all of this can be!

Yellow Teeth