We are happy to work with you and your insurance company to receive the maximum benefit possible and encourage you to contact your insurance company or visit its member website to become familiar with your benefits. Please contact us at email@example.com if you have additional questions.
HOW DOES ORTHODONTIC INSURANCE WORK?
There are several different agreements between insurance carriers and their subscribers, each with different benefits. Orthodontic insurance generally differs from medical or dental insurance in that it rarely pays the orthodontic benefit maximum in full at the start of treatment. This means your insurance policy needs to be active for the duration of treatment in order to receive your full benefit.
Most insurance plans make an initial payment followed by monthly/quarterly installments over the course of treatment. Our office submits total case fees on the initial claim to all insurance companies. The insurance company then makes calculations and pays based on these calculations. These calculations are not disclosed to our office. Additionally, some plans require that we submit manually on a monthly/quarterly basis after the initial payment is received. Because the patient is under the care of one of our orthodontists for the duration of treatment, fees are submitted regardless if the patient is seen in our office during a calendar month.
IS THE BENEFIT LISTED ON MY CONTRACT GUARANTEED?
The agreement of the insurance company to pay for treatment is a contract between you and your insurance company, and the responsibility for treatment costs rests with the patient or parent/legal guardian. While we verify benefits prior to treatment, we can only estimate out-of-pocket costs based on information provided by your insurance company or information available on its website.
You may not receive the entire benefit if:
- Orthodontic related claims are submitted by other providers before or during treatment
- Your insurance coverage terminates before paying out the maximum benefit
- Your orthodontic benefit maximum is reduced during the course of treatment
- The patient exceeds any age limitations during the course of treatment
- Your insurance carrier changes during treatment
Our office may not be aware of any changes to the policy until we are notified by the responsible party, or until the insurance company indicates a final payment has been made.