If you have orthodontic insurance, or believe you may have coverage, please be certain to inform our staff. We do participate with several dental plans including Delta Dental, Metlife, Cigna PPO, Guardian PPO, Aetna PPO, UnitedHealthcare, Careington, and Horizon BC/BS. Our office will send a completed form into the insurance carrier to receive pre-authorization of coverage to make certain that your insurance will indeed cover the orthodontic therapy. Our office manager Desiree handles all insurance issues.
How does orthodontic insurance work?
There are many different agreements between insurance carriers and their subscribers, and each contract provides a different benefit. However, orthodontic insurance generally differs from regular dental insurance in that each insured individual has a lifetime maximum benefit for orthodontic services, not a yearly amount. This benefit is paid as a percentage of the orthodontic fee over time until the benefit maximum has been reached. Charges for lost or broken retainers may not be covered by insurance. Orthodontic coverate is a separate benefit within your dental insurance, just as dental insurance is a different benefit than medical insurance. Your use of your dental insurance benefits does not affect the orthodontic financial coverage and vice versa.
How does our office assist you with orthodontic insurance?
We will file your insurance with the appropriate insurance carrier. We will fill in all information regarding diagnosis, treatment, time, and fees. You must complete the top portion of the claim form and sign it in all indicated locations.
We can work with you and the insurance company in one of two methods:
Option # 1: You will assign the benefits to us and we will accept payment directly from your insurance carrier and credit your pre-authorized coverage amount in full towards your account balance. You will simply be billed for the difference. Your financial arrangements will be based solely upon your remaining balance after your total anticipated insurance coverage has been credited. Therefore, your initial and monthly payments will be reduced. Your computed statement will show you each month your amount due now, which is the amount you owe. On the bottom of this statement will also be the amount the insurance has paid. If for any reason your insurance coverage is cancelled or there is a shortfall, you are responsible for the amount the insurance company has not paid. It is our recommendation that Option # 1 is your best method of handling your insurance payments.
Option # 2: We will not receive reimbursement from your insurance carrier. Instead, all insurance payments will go directly to you. Our financial arrangements with you will be based on the full treatment fee. This means that your initial fee and monthly payment will be increased relative to Option # 1.
Please realize: Orthodontic insurance payments are paid out over the time of the treatment; for a full case this is generally over a two-year period. We do not receive the insurance reimbursement coverage in one lump sum payment.