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Managing Minor Patients: Questions & Answers

June 21, 2019 1369

Consent to Treatment

With divorced parents, do both parents have to consent to treatment of their child?

Typically, consent by one parent who has custody of a minor child is sufficient to start treatment, especially if that one parent is the only one responsible for payment. However, if both parents are financially responsible, it would be wise to have both parents consent to treatment or to have both parents agree that one of them will be responsible for treatment decisions.

It is possible that a parent may have a court order that requires both parents to consent, or a court order prohibiting the other parent from making healthcare decisions for a child. If such assertions are made, a dental practice should request a copy of the court order.

May a step-parent consent to treatment of a minor?

A step-parent cannot give legal consent to treatment for a stepchild, unless the step-parent has legally adopted the child or been designated a legal guardian. A child’s parents or legal guardians may sign a statement authorizing a third party to con- sent to care. Keep a copy of the authorization signed by the parents or legal guardian in the child’s records.

Regardless of whether the step-parent is the child’s adoptive parent or legal guardian and can provide treatment consent, a step-parent may be financially responsible for the minor patient’s treatment, and often a step-parent’s dental benefits will be utilized. In this case, the step-parent may have access to the financial documentation, but unless the child’s adoptive parent or legal guardian, may not have access to the minor patient’s treatment records.

Can a minor consent to dental treatment?

An emancipated minor may consent to his or her own dental treatment. Otherwise, minors cannot give consent for dental or general healthcare treatment. Minors who are 12 years old or older have certain consent rights, but only with regard to diagnosis and treatment for drug and alcohol abuse, pregnancy, sexual assault, infectious and communicable diseases, HIV/AIDS, sexually transmitted diseases, and outpatient mental health.

I understand an emancipated minor can consent to his or her own treatment? What is an emancipated minor?

An emancipated minor is an individual under 18 years 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.

How do I obtain consent for a minor patient whose parents are no longer in the child’s life?

A legal guardian or an adult caregiver may give consent. If the child is in the dependency system, the court will determine who can give consent for dental treatment. A social worker may provide consent for treatment under specific situations. For more information, see the website of Teen Health Law, teenhealthlaw.org

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 care-taker 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 (non¬legal 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?

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 if fourth.

However, if a court order designates only one parent financially responsible for a patient’s healthcare expenses, then that par- ent’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. 

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.