We are happy to work with you and your insurance company to help you receive the maximum benefit possible under your policy. We have found that the more you know about your individual policy, the easier it is to process your claim. To assist us in this endeavor, we have established the following answers to the most commonly asked questions.
Please keep in mind that our primary financial relationship is with our patients and their families. We realize that understanding your orthodontic insurance can be difficult, and we welcome any questions you have.
There are many different agreements between insurance carriers and their subscribers, and each contract provides a different benefit. For example: some programs pay monthly, others quarterly. Some programs cover adults and others cover only children. There may be other qualifications as well. Orthodontic insurance generally differs from regular medical insurance in that it rarely pays for orthodontic treatment in full. Each insured individual usually has a lifetime maximum benefit for orthodontic services. This benefit is generally spread out over the length of the orthodontic treatment. Please be aware that termination of any insurance policy before payment is received will also stop the insurance payments. Charges for lost or broken appliances are also not covered by insurance.
We recommend that you call your insurance company to learn as much as possible about your program and confirm that you have coverage and determine any deductible that will need to be satisfied. Ask how often it pays, lifetime maximum age limitation (when applicable), whether payment will start immediately when treatment is started or whether there is a waiting period. If possible, it is a good idea to get the name and telephone number of the person you speak with.
Remember that there are often circumstances that will cause your estimated insurance benefit to change. Some of these reasons include: employer changing insurance carriers; change in insurance benefit level; change in job during treatment. If a change in your insurance occurs, please notify us as soon as possible.
Once you provide us with your completed and signed insurance form, we will submit it with the description of the orthodontic problems, the required treatment, the length of treatment time and the financial arrangements. We will follow up with the insurance payments once treatment is started. The information we obtain is only an estimate of your orthodontic coverage. If the insurance does not pay the maximum estimated amount, you will be responsible for paying the remaining balance.