Dentist refusing to refer to specialist?

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z91
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Dentist refusing to refer to specialist?

Post by z91 » Tue Nov 28, 2017 5:29 pm

To preface the mods, I am not looking for medical advice, just looking at how to deal with this situation as a consumer.

Hi All,

My son is 5 and has Autism. He refuses to sit in the dental chair and has never had a full exam done. We all agreed (dentist, myself, my wife) that he requires some dental work (he has a dental abscess that needs to be treated ASAP -- tooth will need to be pulled) and can only be satisfactorily performed under general anesthesia. He referred us to 3 different specialists as he doesn't have space for anesthesia work until May. My son will need work much sooner than that. I found a specialist from a local support group (who some of my colleagues used as well) and they will only take us up if the primary dentist refers us. The referral consists of a form with questions that ultimately finds out whether or not the patient needs anesthesia (which we already agreed on). The dentist himself said they would cooperate if we found another specialist, which is the case here, but after three calls to their office, they refuse talking to the specialist simply saying they "don't do that." I presume because it's not on their list.

Is there any obligation for them to provide this information to them? Are there any magic words I can tell them to get us the help ASAP? I am calling around town to other dentists as well because it is important our son gets the support he needs, but our primary dentist has all of the information which would make things move along quickly. Going to another dentist would require us getting an initial appointment and essentially another exam. It's been extremely frustrating so far.

Jonathan
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Re: Dentist refusing to refer to specialist?

Post by Jonathan » Tue Nov 28, 2017 5:47 pm

What kind of specialist? Pediatric dentist? Special needs dentist?

Specific measures are suggested for autistic dental patients: https://en.wikipedia.org/wiki/Special_n ... tal_Clinic

It's possible your pediatrician can do a referral. Understood on the frustration here - it's essentially a $200 initial exam cost for every dentist that you want to consider.

mws13
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Re: Dentist refusing to refer to specialist?

Post by mws13 » Tue Nov 28, 2017 5:55 pm

We have a 20 year old Autistic son, and the dentist today is pretty easy for him. Not so much when he was 5 years old....

This sounds ridiculous on the part of BOTH dentist. We live in NYC, so there are always options. I appreciate that you may not have the same number of options, but I would find a new dentist without these ridiculous referral rules.

It is about your son, NOT them.

Good luck.

PS - Here is his dentist -https://www.parkavepd.com/doctors/ann-lambert-dds/

staythecourse
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Re: Dentist refusing to refer to specialist?

Post by staythecourse » Tue Nov 28, 2017 6:07 pm

mws13 wrote:
Tue Nov 28, 2017 5:55 pm
This sounds ridiculous on the part of BOTH dentist.
Not a dentist, but a physician and agree with above. It is poor patient care for the primary to NOT want to fill out which I am assuming is some simple questions just because they don't normally do that. It is poor patient care for the supposed expert to not take a patient on because the primary won't refer if he/ she agrees the overall assessment. These arbitrary rules is what drives me crazy about ANYTHING in life. In my practice, nearly every decision I make is based on each patient. In this situation I don't see anything unusual you are requesting.

If it was me I would vote with my feet and change primary dentist AND likely find a different specialist. They are doing what is best for them and you should do what is best for you and your child. Since he/ she is only 5 and has autism this will be a problem again and again. Best to find a different direction now.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

z91
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Re: Dentist refusing to refer to specialist?

Post by z91 » Tue Nov 28, 2017 6:33 pm

Thanks all.

I ended up finding some referrals from colleagues and it just so happens my other son's dentist actually has another practice which provides the specialist work needed. I thought it was clear, but to answer the earlier question, we are looking for a dentist that will work with an anesthesiologist, as not all dentists can coordinate that type of work.

The new dentist needs to do an exam, but I am thankful my insurance is good enough where the exam will be <$50, even though we are past our two year "free" maximum. They also somehow have an opening for anesthetic work in two weeks, which I am jumping on.

The other dentist has not called back yet, even though they promised to. Looks like they'll be getting some online reviews shortly. It's such a shame as they came highly recommended from friends :(

stlrick
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Re: Dentist refusing to refer to specialist?

Post by stlrick » Tue Nov 28, 2017 7:25 pm

Are you in a city with a dental school or near a hospital that has a General Practice Residency in dentistry? In both of these locations, anesthesia management is routine. At the dental school, you do not want student care, but there is often a faculty practice or a graduate specialty program in Pediatric Dentistry.

staythecourse
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Re: Dentist refusing to refer to specialist?

Post by staythecourse » Tue Nov 28, 2017 9:15 pm

t60 wrote:
Tue Nov 28, 2017 6:33 pm
Thanks all.

I ended up finding some referrals from colleagues and it just so happens my other son's dentist actually has another practice which provides the specialist work needed. I thought it was clear, but to answer the earlier question, we are looking for a dentist that will work with an anesthesiologist, as not all dentists can coordinate that type of work.

The new dentist needs to do an exam, but I am thankful my insurance is good enough where the exam will be <$50, even though we are past our two year "free" maximum. They also somehow have an opening for anesthetic work in two weeks, which I am jumping on.

The other dentist has not called back yet, even though they promised to. Looks like they'll be getting some online reviews shortly. It's such a shame as they came highly recommended from friends :(
Another avenue is find out which hospitals they have dentist on staff. Children hospitals routinely have dentists doing these cases under GA.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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cheese_breath
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Re: Dentist refusing to refer to specialist?

Post by cheese_breath » Tue Nov 28, 2017 10:07 pm

t60 wrote:
Tue Nov 28, 2017 5:29 pm
... The dentist himself said they would cooperate if we found another specialist, which is the case here, but after three calls to their office, they refuse talking to the specialist simply saying they "don't do that." ....
Who is "They"? Possibly one of the office staff? Phone them back and tell them the dentist said they would, and if that doesn't work talk to the dentist directly. Sometimes the office staff will make their own rules without the boss knowing.

Many decades ago when I was working at the University I decided I'd like to take some history courses for my own personal fulfillment. At the time I was responsible for the University's student records computer systems and knew the Director of Admissions very well. I mentioned it to him, and he said: "No problem. Just fill out an application to make it official." When I submitted the application to the Admissions secretary she asked about my educational objective. I told her I just wanted to take a few courses for personal fulfillment, and she condescendingly told me: "We don't do that here." But when I told her "I talked to (Admissions Director's name), and he said it was OK" she changed her tone fast.
The surest way to know the future is when it becomes the past.

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celia
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Re: Dentist refusing to refer to specialist?

Post by celia » Wed Nov 29, 2017 12:05 am

t60 wrote:
Tue Nov 28, 2017 5:29 pm
He [the primary dentist] referred us to 3 different specialists as he doesn't have space for anesthesia work until May. My son will need work much sooner than that. I found a specialist from a local support group (who some of my colleagues used as well) and they will only take us up if the primary dentist refers us.

...The dentist himself said they would cooperate if we found another specialist, which is the case here, but after three calls to their office, they refuse talking to the specialist simply saying they "don't do that."
Are you seeing the primary dentist, by any chance, as an HMO dental insurance patient? If so, they can limit who they will refer you to since they will have to pay the bill from the specialist.

z91
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Re: Dentist refusing to refer to specialist?

Post by z91 » Wed Nov 29, 2017 1:44 pm

celia wrote:
Wed Nov 29, 2017 12:05 am
t60 wrote:
Tue Nov 28, 2017 5:29 pm
He [the primary dentist] referred us to 3 different specialists as he doesn't have space for anesthesia work until May. My son will need work much sooner than that. I found a specialist from a local support group (who some of my colleagues used as well) and they will only take us up if the primary dentist refers us.

...The dentist himself said they would cooperate if we found another specialist, which is the case here, but after three calls to their office, they refuse talking to the specialist simply saying they "don't do that."
Are you seeing the primary dentist, by any chance, as an HMO dental insurance patient? If so, they can limit who they will refer you to since they will have to pay the bill from the specialist.
Not in this case.We told them we'd be looking at all providers and didn't really care about cost (obviously it needs to be reasonable). I have a feeling they care more about their kickbacks than my son's health. Still no call from them today on whether or not they are willing to do it, even though they promised to call me back if it was a no.

It's not really even a referral, more of a recommendation of, "this kid needs to go under if he gets any dental care, because there's no way he will sit in the chair no matter what we do."

voodoo72
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Re: Dentist refusing to refer to specialist?

Post by voodoo72 » Wed Nov 29, 2017 2:34 pm

I am a dentist, so I will speak from experience, are you in the US? The reason I ask you could simply go to another dental office to get an exam and tell them to give you a referral to the place that you want. I don't see how this would be that difficult.

Good Listener
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Re: Dentist refusing to refer to specialist?

Post by Good Listener » Wed Nov 29, 2017 8:29 pm

I do not understand why the specialist requires the general dentist to say they believe anesthesia is needed. That's ridiculous. Maybe you need a new specialist.

Also, the child will require regular dental visits. My 29 year old autistic daughter goes with me every 6 months. Sh opens her mouth and they do the stuff. We had her school work on it with her when she was 4 or 5 and you may want to get that going.

briansmt4
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Re: Dentist refusing to refer to specialist?

Post by briansmt4 » Wed Nov 29, 2017 8:56 pm

I'm a dental specialist (oral surgeon) and understand the various issues. I have always felt that the patient (or parents) should be empowered to choose who they want to see and have always taken patients without a referral, without question. Most pediatric dentists do this as well and many are the primary care dentist for child patients because that is where the parents take them. I'm surprised that the pediatric dentist won't see your son without something from the general dentist. I would try another pediatric dentist. Let them know your son is autistic. I hope he can get care soon.

chrisdds98
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Re: Dentist refusing to refer to specialist?

Post by chrisdds98 » Wed Nov 29, 2017 9:51 pm

celia wrote:
Wed Nov 29, 2017 12:05 am
t60 wrote:
Tue Nov 28, 2017 5:29 pm
He [the primary dentist] referred us to 3 different specialists as he doesn't have space for anesthesia work until May. My son will need work much sooner than that. I found a specialist from a local support group (who some of my colleagues used as well) and they will only take us up if the primary dentist refers us.

...The dentist himself said they would cooperate if we found another specialist, which is the case here, but after three calls to their office, they refuse talking to the specialist simply saying they "don't do that."
Are you seeing the primary dentist, by any chance, as an HMO dental insurance patient? If so, they can limit who they will refer you to since they will have to pay the bill from the specialist.
what?? where did you hear that from?

voodoo72
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Re: Dentist refusing to refer to specialist?

Post by voodoo72 » Thu Nov 30, 2017 9:00 am

Pediatric dentist don't typically require referals, they are basically same as GP, only a small part of their base is referals, perhaps there is more to the story.

z91
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Re: Dentist refusing to refer to specialist?

Post by z91 » Thu Nov 30, 2017 2:58 pm

I agree this is all a bit strange. The dentistry that I was previously trying to get my son into only does dental work under general anesthesia, and will only see patients if their primary dentist (general, pediatric etc..) already tried basic methods and concluded that work could not be done without the anesthesia. There is a form that needs to be filled out and is fairly simple (IMO) so I have no idea why they refuse to fill it out. The form simply asks what kind of dental work is required, what methods were attempted, and why the patient is a candidate for anesthesia (in our case, psychological).

It's infuriating to me that the dental office isn't returning my calls and finds that ignoring the issue will resolve it for them. Just thought there might be a phrase or something I could say that would obligate them to cooperate. At this point I'm looking to reduce frictions in our lives so I'll just ignore them too, since we already found a new dentist that is happy to work with us.

toofache32
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Re: Dentist refusing to refer to specialist?

Post by toofache32 » Thu Nov 30, 2017 11:29 pm

celia wrote:
Wed Nov 29, 2017 12:05 am
t60 wrote:
Tue Nov 28, 2017 5:29 pm
He [the primary dentist] referred us to 3 different specialists as he doesn't have space for anesthesia work until May. My son will need work much sooner than that. I found a specialist from a local support group (who some of my colleagues used as well) and they will only take us up if the primary dentist refers us.

...The dentist himself said they would cooperate if we found another specialist, which is the case here, but after three calls to their office, they refuse talking to the specialist simply saying they "don't do that."
Are you seeing the primary dentist, by any chance, as an HMO dental insurance patient? If so, they can limit who they will refer you to since they will have to pay the bill from the specialist.
I was also thinking this smells like an HMO.

toofache32
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Re: Dentist refusing to refer to specialist?

Post by toofache32 » Thu Nov 30, 2017 11:36 pm

briansmt4 wrote:
Wed Nov 29, 2017 8:56 pm
I'm a dental specialist (oral surgeon) and understand the various issues. I have always felt that the patient (or parents) should be empowered to choose who they want to see and have always taken patients without a referral, without question. Most pediatric dentists do this as well and many are the primary care dentist for child patients because that is where the parents take them. I'm surprised that the pediatric dentist won't see your son without something from the general dentist. I would try another pediatric dentist. Let them know your son is autistic. I hope he can get care soon.
Oral surgeon here also. This doesn't make sense. My partner has an autistic son. Call my office and we will schedule you. We will try to get info from the other office but if we can't, we'll get you in and figure out your needs on our own just like the original dentist did. Yes the patient will need an exam and consultation from me because I am the one providing the treatment and I have to decide the setting, time, supplies, and requirements for treatment based on the patient's individualized needs.

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White Coat Investor
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Re: Dentist refusing to refer to specialist?

Post by White Coat Investor » Thu Nov 30, 2017 11:56 pm

staythecourse wrote:
Tue Nov 28, 2017 6:07 pm
mws13 wrote:
Tue Nov 28, 2017 5:55 pm
This sounds ridiculous on the part of BOTH dentist.
Not a dentist, but a physician and agree with above. It is poor patient care for the primary to NOT want to fill out which I am assuming is some simple questions just because they don't normally do that. It is poor patient care for the supposed expert to not take a patient on because the primary won't refer if he/ she agrees the overall assessment. These arbitrary rules is what drives me crazy about ANYTHING in life. In my practice, nearly every decision I make is based on each patient. In this situation I don't see anything unusual you are requesting.

If it was me I would vote with my feet and change primary dentist AND likely find a different specialist. They are doing what is best for them and you should do what is best for you and your child. Since he/ she is only 5 and has autism this will be a problem again and again. Best to find a different direction now.

Good luck.
Worst case scenario you shouldn't have to do anything more than pay the dentist for his time to fill out the form. But if you're wanting it filled out for free, I can understand why an office would "not do that." I "don't do that" too with some of the forms people bring to me wanting me to fill out. You wouldn't believe some of the paperwork some people want a doctor to fill out.
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celia
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Re: Dentist refusing to refer to specialist?

Post by celia » Fri Dec 01, 2017 12:30 am

chrisdds98 wrote:
Wed Nov 29, 2017 9:51 pm
celia wrote:
Wed Nov 29, 2017 12:05 am
Are you seeing the primary dentist, by any chance, as an HMO dental insurance patient? If so, they can limit who they will refer you to since they will have to pay the bill from the specialist.
what?? where did you hear that from?
I assumed dental HMOs works the same as medical HMOs, but maybe not. I have trouble finding a reference, but found one saying the dentist needs to write a referral so the specialist can be paid (possibly by the insurance company?). Without a referral, the patient would have to pay.

My past experience with medical HMOs and trying to get outside referrals helped form the insurance choices we make today. The last specialist we saw commented that they don't accept HMO insurance since they are too slow to pay. Here is a reference showing that medical HMOs pay (or used to pay?) the specialists they refer the patient to:
https://www.kevinmd.com/blog/2012/01/pr ... lists.html says:
Back in the days of capitated care, there was pressure from HMOs to reduce the amount of referrals, as doctors were given a set fee to manage each patient. A referral meant a financial hit to the practice. But the HMO model was rejected by patients, who didn’t like their choice restricted and accused doctors of holding back care.

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