Insurance / Financial
You are here because you’re considering orthodontic care for yourself or a loved one, but have questions about the cost, and whether dental insurance covers orthodontic treatment. When deciding to start orthodontic treatment, the fee arrangements may often influence timing. Therefore, this is a significant component of the decision-making process. It is important to bear in mind that the value of orthodontic treatment makes it a worthwhile investment.
Every patient has a different case. Therefore, the fee charged for treatment will vary. We emphasize on evaluating each case individually in order to provide a proper estimate. Our complimentary initial examination provides patients with an opportunity to better understand their needs. It also allows us to determine an estimate. When indicated, records will be offered to properly diagnose the case.
In order to make orthodontic treatment affordable, we offer different payment options.
Inside office financing: Payment over time is a popular option. Luckily, we do offer this in our office. This option is an interest free payment plan, consisting of an initial payment and the balance spread out over the course of treatment. The smaller monthly payments without interest make this an attractive option. With this option, we offer convenient automatic payments and payment coupon books.
Outside office financing: Our office can also provide private financing options. These plans may allow for no initial payment, deferred interest and extended monthly plans. We currently offer plans with CareCredit.
Reduced fees with accelerated payment plans paid at the initiation of treatment.
To help offset fees, the insurance payment portion is critical. With that in mind, we accept all insurances. Our office will submit all paperwork and will apply any benefit received in-office toward your fees. We currently participate with the following Insurance Carriers:
• Assurant/Dental Health Alliance
• United Concordia
• Delta Dental
• Met Life
• Pro Benefits/Dental Shop/Dental Pay Plus
When evaluating insurance, we make a distinction between participating and non-participating providers. Although both provide submission services for your claims and can accept insurance payments, a participating provider may be more advantageous.
The benefits of seeing a participating provider include:
• Lower treatment fees
• Lower out-of-pocket expenses
• Increased insurance benefits
Orthodontic insurance is usually provided as an added benefit to private dental insurance. Plans can vary considerably with different carriers. During the complimentary initial consultation, we will provide you with an understanding of your benefit help to explain the nuances of your plan. It is important to understand your benefits before any treatment begins.
What Will Insurance Cover?
The first visit to our office is complimentary and will not result in any charges. Therefore, an insurance claim is not necessary. Although we will request insurance information prior to the first visit, it is only so our staff can help determine the available coverage to inform you of your benefits. While insurance may seem difficult to understand, the benefits can help reduce the financial burden.
Since every plan is different, the following concepts will be discussed:
• Covered percentage and lifetime maximum
• How the benefit is paid
• Coordination of benefits
Covered Percentage and Lifetime Maximum
Orthodontic insurance will cover a percentage of the fee. This percentage can vary and covers a portion of the fee. A plan that has 50% coverage unfortunately does not necessarily cover half of the fee due to the lifetime maximum allowance. The defined lifetime maximum varies among carriers and plans.
How the benefit is paid
Every insurance plan will pay the benefit differently. Few companies will pay the full benefit at the start of treatment, while most pay throughout the course of treatment on a monthly or quarterly basis.
Coordination of benefits
When there are multiple dental insurance coverage’s, each plan may have conditional coverage based on what another plan covers. Usually, dental insurance companies will coordinate the benefits using a birthday rule. That is, the insured with the earlier month/day of their birthday will be considered primary, while the other will be considered secondary.