#orthodonticinsurance

The first question will be easy enough to find out, the second can be a bit complicated.

Orthodontic insurance is separate from medical and dental. If you have dental insurance, it’s quite possible that you have Orthodontic benefits however Orthodontic benefits are separate from your normal dental insurance with your general dentist. There are a few medical plans that have orthodontic benefits only if the braces are medically necessary.

Orthodontic benefits are paid over the course of the treatment and normally have a lifetime maximum per patient. The average time for orthodontic treatment is 24 months. In that case, your benefit would be paid over 24 months. Only 1% of insurance companies pay your orthodontic benefit in full in one payment.

Orthodontic benefits work in several ways:
The most common benefit is payable at a percentage with a lifetime maximum of a certain amount. For example: payable at 50% with a lifetime maximum of $1500 per person. This means if your treatment is $4000 they will pay $1500 total. Additionally, they will not pay their amount in full as they know most treatment plans may take anywhere from 18 to 30 months so most orthodontic plans usually pay one of 2 ways; either half of their benefit at the beginning and half one year later, or a percentage at the beginning and then monthly payments throughout the course of your treatment.

If you change employers and/or insurance companies during the course of your orthodontic treatment we need to know right away.

If you are working for the same employer and that employer changes insurance companies during your orthodontic treatment, we can submit a claim to the new insurance company. That claim will be prorated according to the date the braces were put on and the number of months required. The new insurance company will consider how many months the prior insurance company has paid and how many months are left of treatment. In this case, usually, the new insurance company will pick up the payments where the other company has left off. We say ‘usually’ because when you have the same employer, your benefits should continue even though your employer has changed insurance companies. But, in some cases, there might be a pre-existing clause in your new benefit and the new insurance company will not continue payments. If this is the case, you may personally want to try to appeal to get your full benefit from your employer.

If you change employers, your benefit from the first employer will be stopped automatically and they will not pay any more at that point. You can submit a claim to your new insurance company from your new employer and location. If your new plan allows for “Ortho Work in Progress”, the new insurance should pick up payments when you send in a claim and submit the amount of months left of treatment. Sometimes this is not covered due to a pre-existing clause in your new benefit.

Additionally, since Insurance companies do not pay their portion of your benefit in full, if you drop your Orthodontic coverage they will stop payments at that time and you will not receive the full benefit which means at that point you will be responsible for that full amount.

In a nutshell: Insurance can be complicated for orthodontic treatment due to the length of treatment and different plan types. It is important to know your benefit, lifetime maximum, how it is paid and at what percentage. We are happy to help you navigate the details of your Insurance Company but we ask that if there are any changes, or even if you are contemplating making a change, let us know right away so we may help you receive your maximum benefit.