We believe finances should never be an obstacle to a beautiful smile. In addition to a discount for each additional member of your family we treat after the first child, we offer a variety of payment options to meet your needs:
- Payment in full at the beginning of treatment with a fee discount
- No-interest payment plans spread out over a period of months
- Initial payment as low as $850
We will thoroughly explain each of these options so that we are able to accommodate your needs. For your convenience, our office accepts cash, check, MasterCard®, Visa®, Discover® and American Express®.
Our office is committed to helping you maximize your insurance benefits. Because insurance policies vary, we can only estimate your coverage in good faith but cannot guarantee coverage or payments due to the complexities of insurance contracts.
Our office will prepare the necessary forms to assist you in collecting your benefit. However, please remember, that almost all plans pay only a portion of your fee. We do accept most insurance, whether or not we are listed as in-network with your carrier. We can assist you with your flexible spending account (FSA) questions as well.
When you first visit our office, bring your current insurance card with you. If you change insurance companies or join another employer’s plan, please be sure to let us know.
We will fully attempt to help you receive full insurance benefits; however, you are personally responsible for your account.
Understanding orthodontic insurance benefits
At various times of the year, many employers offer their annual open season where employees have the option of changing, adding, or even dropping medical and dental coverage. Understanding orthodontic benefits can oftentimes be a little bit trickier to figure out than regular dental benefits. Here are a few tips to help you understand your coverage and a few questions you may want to ask when considering changing or adding dental plans as it relates to orthodontic coverage.
1. Just because you have dental insurance does not mean you have orthodontic coverage. Be sure to ask if your plan covers both dental and orthodontic procedures.
Sometimes there are higher premiums for both dental and orthodontic coverage but often there are not. Each company is different. You will want to make sure you are not paying more for the insurance than what you are getting in benefits.
2. Orthodontic coverage typically involves a Lifetime Maximum Benefit (LTM) that pays out at 50% of the total case fee.
This means they will pay for orthodontic treatment one time, and once you have used all of the LTM, they won’t pay anymore. Every dental insurance company has a different “reasonable and allowable” fee for orthodontics. A reasonable and allowable fee is when a dental insurance company has a cap on what it will allow for braces. For instance, if you have an LTM of $3000 that pays at 50% and your insurance company has an allowable fee of $5000, you would only receive $2500 of your $3000 maximum. If your employer changes plans while you or your child is in treatment, the orthodontic payment history will typically follow you. However, if you take out a new plan with a completely different company, oftentimes, the history does not follow you, and this can result in additional benefits. Be sure and let us know anytime your insurance changes.
3. Orthodontic benefits payout throughout treatment, not in one lump sum payment.
If your benefit is estimated at $1500, the insurance company generally pays you an initial payment when the braces are placed and then monthly, quarterly, or annual installments for the remaining months of treatment. If you are estimated to be in treatment for 18-24 months, then you would want to make sure to keep your dental plan during those two years. If you drop your dental/orthodontic insurance before your benefit has finished paying, this can result in more out-of-pocket expenses for you.
4. Does your plan have a waiting period for orthodontic coverage?
Some dental plans require a waiting period before they will pay for braces. They might cover cleanings and general dentistry immediately; however, sometimes you will have to wait as long as a year before orthodontic coverage is active. Be sure to ask your dental plan if there is a waiting period.
5. Can I have dual coverage for braces?
The answer is yes in most cases, but there are a few rules insurance companies follow when determining primary vs. secondary. You will also want to make sure that your plan allows for Standard Coordination of Benefits, which means the insurance will work together and that both of them will make payments. You will also need to ask if the secondary plan has a non-duplicating clause. A non-duplicating clause means the secondary insurance will not pay anything the primary insurance has already paid. If both plans have an LTM of $1500 but the secondary has a non-duplicating clause, you would only receive $1500 from the primary insurance and nothing from the secondary insurance. When coordination of benefits is allowed, then your benefit could be as much as half of the allowable amount, but in most cases, you will not receive the full amount from the secondary insurance. The Birthday Rule determines which plan is primary and which plan is secondary. The birthday rule goes by birth month, not age. For example, if mom’s birthday is 2/14/73 and dad’s birthday is 11/20/68, mom’s plan (in most cases) would be considered primary because her birth month falls first in the calendar year.
6. What happens if you get orthodontic coverage after you/your child has started treatment?
Sometimes an employer may add orthodontic coverage to the plan or you may change employers and find yourself with orthodontic benefits that you did not have when you started treatment. The question to ask about your new plan is if it will cover work in progress. If they do cover work in progress, then generally your benefit is pro-rated based on how long you have been in treatment and how long you have left in treatment.
We hope you find this information useful, and as always, if you have further questions, please don’t hesitate to call our office.