Is it okay for a minor patient to be unaccompanied by a parent or guardian when undergoing treatment?

If the parent or guardian has already consented to the treatment to be performed, it is generally all right to proceed with treatment. Should treatment change in any manner, the parent should be notified. However, if a dental practice prefers to have a parent or guardian present during a minor patient’s treatment, be sure to make it an office policy and inform employees, patients, and their families.

Should the parent or guardian request a non-legal guardian, such as a caretaker or relative, accompany the patient to an appointment, the practice should inform the parent/guardian that the non-legal guardian cannot make treatment decisions for the patient. The practice may wish to have parents/guardians sign the Authorization for a Care-taker (non­legal guardian) to Accompany a Minor to Appointments form found on cda.org/practicesupport.

Coordination of Benefits

We have a new patient—a minor whose parents are divorced with joint custody and the mom has remarried. How do we determine which dental benefit plan to bill?

You can start by using the Coordination of Benefits-Patient Questionnaire, available at cda.org/practicesupport. The questionnaire helps you obtain the information you need to determine who is responsible for payment.

If the patient is covered by two or more dental benefit plans, the plan you bill first is determined in the following order:

1. The plan of the parent with custody of the patient. If parents have joint legal custody, the plan of the parent whose birthday is first in the calendar year is primary. If both parents have the same birth month, the plan that has been in effect the longest is the primary plan.
2. If only one parent has custody and that parent has remarried, the plan of that parent’s spouse provides secondary coverage.
3. The plan of the noncustodial parent is third.
4. The plan of the noncustodial parent’s spouse is fourth.

However, if a court order designates only one parent financially responsible for a patient’s healthcare expenses, then that parent’s plan is the first to determine the benefits.

Refer to Chapter 4 of the Dental Benefit Plan Handbook, Understanding Coordination of Benefits, for additional information, especially on ERISA plans. The handbook is available on cda.org/practicesupport.

I thought the healthcare reform legislation required insurance plans to provide benefits to a beneficiary’s adult children up to 26 years old.

The requirement applies only to medical plans, and not to dental or optometry plans. A bundled health/dental plan may voluntarily extend dental coverage to adult children up to 26 years old, and a plan purchaser may choose to cover the cost of the extended coverage.

Access to Records

Are there any circumstances under which a parent cannot have access to his or her child’s dental records?

A parent generally has a right to access the dental record of his or her minor child irrespective of whether the parent has custody or financial responsibility. A dental practice may refuse to give access to a parent if it determines that providing access may harm the patient. The practice must comply with a court order that prohibits a parent from obtaining access to records. If a practice refuses a parent’s request for access to a child’s dental record, the reason should be documented.

If a minor patient provides information to the dental practice with regard to his or her drug or alcohol abuse, pregnancy, sexual assault, infectious and communicable disease status, HIV/AIDS status, sexually transmitted disease, or mental health, the practice may not release this information to a parent without the minor patient’s consent.

A parent does not have a right to access the health record of an emancipated minor. An emancipated minor is an individual under 18 yrs old and is either (a) married or divorced; (b) is on active duty with the US armed forces; or (c) received a declaration of emancipation from the court.

Can a minor patient provide authorization for another entity to access the patient’s record?

Only an emancipated minor can provide such authorization. Upon reaching the age of majority, the patient can provide authorization.

Who can give consent for a minor in jail whose parents aren’t available?

Welfare and Institutions Code 726(a) states that if the courts choose to remove the parent’s right to consent for a minor patient it must be in a court order, meaning obtaining that court order will direct you to the appropriate consenting party. In most cases, this is the Probation Officer but could also be the Juvenile Court Caregivers, Department of Corrections or the Department of Juvenile Justice. For more information, you can review it here:  Consent to Medical Treatment for Youth in the Juvenile Justice System: California Law 

Who can give consent for minor patients in foster care?

A parent does not necessarily lose their rights to consent for their child while in foster care. A court order should be requested to determine if the Child Protective Services employee or foster parent has been given authority to sign for a minor. 

Resources found on cda.org/practicesupport

• Dental Plan Questions are Attempt to Ascertain Primary Payer
• Dental Benefit Plan Handbook - Understanding Coordination of Benefits