Your orthodontic benefit is a separate policy from your general dental insurance.
All orthodontic policies have a one-time (or lifetime) maximum benefit that they will pay per patient. This amount varies from $500.00 to $2500.00 and depends solely on what your employer wishes to offer its employees.
Some orthodontic coverage is for your children up to age 18-26 only and not a benefit for the adult or spouse policy holder.
Because orthodontic insurance is an ongoing process, the insurance benefit is not all paid out up front. It is split up into an initial payment and either monthly or quarterly payments of the balance. In making our financial arrangements with you, we do consider the insurance benefit before setting up the monthly payments. Our fees are based on the length and complexity of the treatment, not on the limits of your insurance. Our contract is with you, NOT your insurance company, and you will be responsible for the total treatment fee, even if there are changes in your insurance coverage or eligibility during treatment. For insurance purposes, benefits are payable starting with the date the appliances are placed. Therefore, we usually submit the claim on that date.
Should the patient have dual insurance coverage, most companies use the “birthday-rule.” That is to say that the policyholder with the earliest birth date in the year will be considered the primary carrier. The secondary carrier will wait to make any initial payment until the primary has paid. They will want an “explanation of benefits” showing how much the primary carrier plans to pay.
Being informed about your coverage is a great help to us. You will probably want to speak with the employee benefits representative at your place of employment BEFORE your exam appointment. You will want to know the amount of the “lifetime maximum” benefit, how it is paid out, whether it covers adults or just children, and if it needs pre-authorization.
If you have an insurance I.D. card with the social security number, name and address of the carrier, we can take the information from that and generate a computer form. Please be assured that we are here to serve you and help you obtain your maximum insurance benefit.
If you have a flexible spending account (pre-tax money for medical expenses) through your employer, you are responsible for billing and gathering paperwork for reimbursement. If you are unsure if the patient will be ready for treatment the next year, please call and schedule an appointment prior to your enrollment date.