Thursday, October 12, 2017

What to Expect when re-locating with kids in Braces

What to expect when relocating with Kids already in Braces


It is not uncommon at all to be in the middle of braces and end up having to move for a job or family.  As an Orthodontist in a busy city like Austin, we have patients moving in and out at all times.  I also have a lot of kids going into college that have to be finished or retained.  For the Orthodontist it can be challenging but for the patient and parents of patients it can be downright frustrating.  I wanted to provide something of a “help guide” for these patients to help them navigate through the process and the pitfalls (with some explanation from the Orthodontist’s side) of relocating and finding a new Orthodontist.
First, most reputable Orthodontists will not accept in-town transfers without a good cause and a call from the treating doctor.  Also, most (including me) will not accept a case in treatment from a general dentist or Pedodontist no matter the situation as they are untrained and may add significant liability to any case.  As I have written many times, it is so very important to choose a good Orthodontist from the start.  This is why I suggest a private practitioner with his/her own free standing practice (not a strip center company or “dental center”).  Once you begin treatment, you will be bound to the doctor except for extreme circumstances and any change you may want to make will likely cost you in time and dollars.  Orthodontists know these patients are already unhappy and will be, by definition, a challenge to finish.  They also know that they will be partially liable for all work, not just their own efforts so they will be careful before going down that road.
“most reputable Orthodontists will not accept in-town transfers without a good cause and a call from the treating doctor.  Also, most (including me) will not accept a case in treatment from a general dentist or Pedodontist no matter the situation”
Also, make sure if there are several parents with custody concerns that you provide adequate informed consent from all parties that are custodians even if the ex-spouse is in another city or state.  Putting your Orthodontist in the middle of a divorce/custody battle is in no one’s interest.     


If one party wants to treat and another does not (especially if money is involved, the Orthodontist will likely o accept your child as a patient no matter the need.  This is because even if you agree to pay the Orthodontist, when you as parent #1 go to send a bill to parent #2, they will reject it and say they never consented.  Believe me it happens all of the time.  Ultimately it become a mess and can even go to the local state board for adjudication.  No Orthodontist deserves or wants this.

Second, it is important to give your treating Orthodontist as much notice as possible.  If you know you will be relocating in less than 6mo it is probably best to wait until you move though there are circumstances that make starting braces immediately very important such as premature loss of baby teeth or impaction of teeth.  If you are in treatment and know you will be moving, let your doctor know where you will be moving so he/she can start researching the area for a similar practice for you to transfer.  Keep in mind that different Orthodontists may use different braces; if there is significant time remaining or the new Orthodontist just isn’t comfortable with your brackets type, he/she may replace all of the braces which will cost you as the patient.  I try to never replace all brackets/braces BUT I have done so on several cases where I felt there was more than 18mo of treatment remaining or I felt that the braces needed to be moved anyway (raised up from the gumline for hygiene, etc.).  In fact, I review my own cases at 12mo with X-Rays just for this reason, to re-position any brackets that don’t look right at that time.

Next, allow your Orthodontist to recommend a new Orthodontist and send records and notes directly.  This shows the new Orthodontist that everyone is on the same page and it keeps the treatment plan consistent.  Cases transferring mid-treatment will not look the same as they started; it is important to know where a patient came from just as much as knowing what the teeth look like at the time of transfer.  Until the new doctor has accepted your family, make sure kids are brushing well.

Finally, don’t be afraid to talk about the insurance and money with both your current Orthodontist and the new Orthodontist.  I always fill out a financial sheet for the new Orthodontist so thay know our initial fee, what the insurance has/will pay and what the patient has/still needs to pay.  I don’t charge interest for payment plans at my office so it is relatively easy to stop payments and leave the remaining payments (plus a fee for retentions, usually $450 at my office) for the next office.  If the patient tells me they are moving in a few months and I fell they have over-paid a few months, I can stop payments early and even bring them in a little more often to get some more done before they move.  This leaves more money for the new office and may give the patient a lower fee at the new office if more is complete.

Regardless, every patient should expect to pay more for a transferred case v. finishing with the original Orthodontist.  It can go the other way or can be a wash, but do not expect that.  And the worst thing you can do is start off complaining to the new Orthodontist that you are paying them too much.  Remember that they are estimating time remaining from where the patient stands now; they do not have the down payment to carry them if a case is going longer than estimated (can be from missed appointments, compliance, slow eruptions, unexpected growth or just a tough case with really solid bone slowing movements).  The original Orthodontist would likely not increase a fee midstream but you cannot expect a new orthodontist to eat that extra time.
If I get a financial sheet from a transferring Orthodontist, I try very hard to keep the treatment the same assuming progress has been consistent and the fee structured fairly.  I also try to give a complete fee to finish a case if it is longer than 6mo (versus a monthly fee).  It will generally be prorated based on my fee schedule with consideration of the previous doctor’s fees and collected fees.  If a case requires debonding and then placement  of new braces, there will be a significantly higher fee (probably still less than full fee but still significant, maybe 75 to 90% fee).  IF there is only a few months remaining, I will likely charge $150/mo plus retention ($450).  IF they are already in retainers, we will set up a retention protocol based on what they have (retainers) and how their teeth look, cost will likely be around $450.
Just recently I had a patient transfer in with easily 12 to 15mo remaining in an 18 to 24months plan.  Treatment was initiated out of town 12months previously but it had been a few months since the patient saw the previous Orthodontist.  I took new records (something you should always expect from the new Orthodontist as a standard of care) and had a full consult to discuss treatment and present our fee.  In this case, I gave them a 50% discount from my original fee plus a full retention fee (totaling $2875 + $450 for this type of case) as I planned on using their brackets with only repositioning a few based on the films even though they are an unusual blend of two different types of braces that I do not use.  This left them with a down payment of @$800 and monthly fees for the remainder plus a $450 retainer fee. This is likely a little more than what the original Orthodontist would charge because he/she collected several months of insurance without treatment and because now the case is extended beyond the original estimate.  In this case, it looks like the estimate was also about 3 to 6mo off due to excessive patient growth.  Even though the original Orthodontist can probably finish for a little less by taking the hit for the extra time in treatment, I cannot treat for less than half the fee due to the amount of time and treatment remaining.
One thing to remember for the patient above is that you really want to see the new Orthodontist without two months of your previous visit.  Hopefully your old Orthodontist will take fresh records so you can avoid a records fee (usually @$250 to $350) and the new Orthodontist can hit the ground running.
The last thing to remember is that Orthodontics is a science AND an art.  One Orthodontist will likely treat just a little differently that every other Orthodontist.  Sometimes treatment plan and philosophies can very wildly.  This is why it is important for your transferring Orthodontist to help you locate a doctor with similar brackets/prescriptions./philosophies so you don’t end up paying for new treatment just to arrive at the same correction some other way.  Most Orthodontists know if there is another local doctor that can treat a case differently so don’t be afraid to look around if it sounds like a totally new plan after the consult.  And remember that every Orthodontist is trying to give you an excellent result; if they do something a little different, you can trust a certified Orthodontist, especially a Board Certified Orthodontist, will get the job done right.
If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35th street and MoPac.
Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics and is a Diplomate of the American Board of Orthodontics.  Dr. Waters and his wife of 21 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at