Financial Information

Absolutely! Our consultations are complimentary. Further, we want to make orthodontic treatment obtainable for all our patients. You may be surprised how affordable orthodontic treatment can be. Most patients choose to make installment payments over the duration of their treatment, which in most cases is 18 to 24 months, at 0% interest. At your consultation, we will discuss your preliminary treatment plan and, in most cases, provide a quote for treatment. If after that appointment you have financial questions, call to speak with our financial coordinator.

In our experience, for specialty dentistry such as orthodontics, there is typically no difference between in and out-of-network insurance contributions. However, there are exceptions. We would be happy to check into your insurance benefits for you. In network, providers agree to fee limitations for specific CDT (Current Dental Terminology) coded services within geographic areas. We suggest you check with your Human Resources provider if you have questions about your plan’s fee limitations. Unfortunately, if you have a DMO (Dental Management Organization) plan, we unfortunately cannot collect any insurance benefits for you. A DMO is similar to what Group Health is to medical; you have to go to ONLY their providers for services. If you seek services outside of the network, it will be completely out-of-pocket to you.

When you are covered by two dental plans, this is called “dual coverage”. If you are the patient, your insurance is primary and your spouse’s is secondary. In the case of dependent children, insurance companies go by the birth date rule, that being, the person whose birth day and birth month are first in the calendar year (regardless of birth year), is primary. The other parent is secondary. There are exceptions, such as in the case of court-orders as related to divorced parents, step-parents, and dependent children.

Rarely. We would have to look into both plans to find out; there are many variables such as the plan’s life-time maximums, the percentage coverage, the age limits of the plans, and MOST importantly if there is STANDARD COORDINATION OF BENEFITS. Please note our estimations regarding your insurance are NOT A GUARANTEE OF PAYMENT. The insurance company has ultimate control over payments; we are merely the liaison between you and the insurance company.

Some insurance plans have this clause written into them. What this means is that the secondary plan will not pay any benefits if the primary plan paid the same or more than the secondary plan would have paid if it was a stand-alone plan.

We suggest contacting your employer or an insurance broker. However, keep in mind you have to keep insurance plans active for the entire duration of treatment in order to receive the full life-time maximum. The most common life-time maximum benefit we see is $1,500. Will 2 years of an insurance premium cost you more than you will get back in benefits? If so, it won’t be worth getting orthodontic insurance.

Call your insurance carrier to verify your benefits. You can also check with your Human Resources representative, at work. Occasionally, there can be errors in the information that the Customer Service Representatives provide to us over the phone.

Orthodontic insurance is most commonly written as a life-time maximum benefit. That being said, it doesn’t matter in which portion of the year, or years you consume it. Less commonly, orthodontic insurance is written with an annual maximum. Plans that are written that way typically have a 24 month or 2 year maximum, meaning the orthodontic benefit will likely not exceed, for example $2,000 if the annual maximum is $1,000.

This is a choice you or your employer has made. Not all dental insurance plans provide orthodontic coverage. Check with your employer or insurance broker to see if you can change to a plan that offers orthodontic coverage. However, be careful! You don’t want to pay more, keeping a plan that has an orthodontic benefit active for 2 years, if you aren’t going to get back at least that much in life-time orthodontic benefits. The most common orthodontic life-time maximum benefit we see is $1,500.

Contact your Human Resources representative.

Insurance plans have age limits. It is likely that you are not covered because you aren’t within the age restrictions of your insurance plan. These age restrictions apply to several different categories as well. Some plans cover the subscriber only, others the subscriber and spouse. Most plans cover the subscriber, spouse and dependents, but again, there are age limits attached to each grouping. We will be happy to check your benefit for you. You can also check with your Human Resources representative or your insurance broker.

These fees are separate as a benefit to our patients who have insurance. Sometimes, your dental (NOT orthodontic) insurance will cover a portion of your records fees. Billing the insurance separately for these items allows us to possibly collect more insurance money for you, thus reducing your out-of-pocket expenses. If these funds are available for a claim, dental offices can collect them as well.

Insurance companies typically make installment payments over the duration of treatment. Your full life-time maximum benefit will not be reflected as a credit until close to the end of treatment. Further, your personal ledger is separate from the insurance ledger. If you would like a summary of what your insurance company has paid to-date, please contact our financial coordinator.

If you leave your employer before the insurance life-time maximum is reached, no further collections can be made against this insurance plan as you are no longer a member. Unfortunately, we cannot control (via our billings) how the insurance companies pay. Additionally, how you pay your personal portion also has no effect on how the insurance company will pay their portion. The insurance payment schedule is established by your employer and the insurance company when the plan was established.

Please let us know ASAP if your employer changes insurance carriers. Typically, this has no effect positive or negative to your insurance benefits, HOWEVER, it can. The new carrier’s policy may be written differently, there may be a higher or lower life-time maximum for orthodontics. There may be an age limit difference. The best thing to do is check with your Human Resources representative as soon as you know the change is going to occur, to familiarize yourself with the benefits changes, if any. Once you are covered by the new plan, call our financial coordinator to update your benefits. She can let you know if there will any changes to your account as a result.

No, there is typically a grandfather clause that simply picks up where the last policy left off and continues until the life-time maximum has been met.

If you change your employer during treatment, the current insurance will stop making payments once you terminate your employment/benefits. The new carrier provided there is no waiting period and they have orthodontic benefits available within the age limits (if applicable) will pro-rate benefits and pick up where the previous plan left off. Unless the new orthodontic life-time maximum is higher than the first, it is unlikely that you will collect any more benefits than originally estimated.

No, unfortunately the timing of our billing(s) to the insurance company has no effect on their installment payment schedule. Payment schedules are written into the insurance policy at the time the policy is established by the employer or purchased by the individual.

Unfortunately, there is no way to collect the full life-time maximum for treatment if you are no longer insured by that plan. Payments by insurance companies are based upon time of service vs. time of billing. We can bill for you, after you no longer have coverage, as long as the orthodontic services were provided while the insurance was active.

Your “old” insurance carrier will stop making payments because you are no longer insured. Your new carrier, once we bill them, will likely start making pro-rated payments, until the plan’s life-time maximum is met. The assumption is that your new plan has orthodontic benefits with a similar or increased life-time maximum, that the patient is covered and within the new plan’s age restrictions and that there is NOT a waiting period. Further, collecting insurance benefits is based upon when treatment occurred, not the time billing occurred. Please note that there is a “timely” filing requirement which is usually 12 months from the date treatment started.

This is good news! You may now have to pay less out-of-pocket for orthodontic treatment. Let us know your new benefits information and we will look into your new insurance for you. Unfortunately, we will likely not be able to collect the full life-time maximum as benefits are typically pro-rated, depending upon how long ago treatment started.

No, insurance is most commonly written as a life-time maximum. Once the life-time maximum has been met, there are no further benefits to collect.

If for ANY reason insurance coverage is not in force, denied or terminated, the remaining balance will be transferred to the responsible party. Insurance Coverage is NOT guaranteed.

These fees are separate as a benefit to our patients who have insurance. Sometimes, your dental (NOT orthodontic) insurance will cover a portion of your records fees. Billing the insurance separately for these items allows us to possibly collect more insurance money for you, thus reducing your out-of-pocket expenses. If these funds are available for a claim, dental offices can collect them as well.