There is a lot of confusion about medical insurance, dental insurance, and orthodontic insurance. The purpose of this page is to help explain things in a way that will make sense to our patients. Most people have medical insurance. Some people have dental insurance as well. Of those with dental insurance, some have orthodontic coverage for themselves and their children. If you have dental insurance, we will handle all of the paperwork for you free of charge. We will also do what is called “accept assignment of benefits”, meaning that instead of the insurance company reimbursing you after you pay the full amount, we will speak directly with the insurance company to reduce the hassle for you as well as the out of pocket cost.
Orthodontic treatment is nearly always a lifetime benefit and does not renew yearly. It is usually separate from the dental benefit but may include some oral surgery procedures. The orthodontic insurance benefit is commonly a set dollar amount with a percentage. The insurance will pay for the % of treatment up to the lifetime maximum dollar amount whichever is less. For example if your benefit is $1500 at 50% and your treatment fee is $400 it will pay 50% or $200. But if your treatment is $3000 or more, no matter how high the fee, the maximum you will receive is $1500.
Nearly all insurance companies will make an initial payment when the appliances are placed then make payments over the length of treatment. They do this because the adjustment visits are not performed all at once. This means that if you lose or cancel your insurance before treatment is finished you may lose a portion of your benefit. Always check with your provider before canceling your insurance.
Also some orthodontic benefits have a longer waiting period. So although you may have met the wait period for general dental benefits you may have to wait 6-12 months longer before your orthodontic insurance benefit will begin making payments.
If you have two orthodontic insurances, there is a coordination of benefits that has to be checked to see how the benefits will work together. Usually the birthday rule applies meaning whoever’s birthday is first in the year not which is older. If you are lucky they will coordinate and you will get the full benefit from both insurance companies.
Call us today to help us maximize your orthodontic insurance benefits!