At Dietrich Orthodontics, we believe that orthodontic treatment is an investment. Getting your perfect smile takes time and money, and we want to help you maximize your experience, including your insurance benefits! If you have dental insurance through your employer, your plan may include orthodontic benefits. However, these benefits are a little different than standard dental, so our team has your guide to understanding your orthodontic benefits in 2023.
Understanding The Basics of Insurance Coverage
Orthodontic coverage usually involves a maximum lifetime benefit that pays out at a certain percent. For example, an insurance company would pay 50% of the submitted fee, up to the maximum lifetime benefit and then the benefit would be exhausted and payments would cease. Additionally, some plans will pay for braces once and won’t pay for any subsequent relapse later in life.
The first step in the insurance process is determining if your policy is active. Our team will contact your insurance company to verify your eligibility for orthodontic coverage before starting treatment.
Every plan is different and offers unique benefits. Orthodontic benefits are typically separate from the regular dental plan. They often have a one-time use and cover a portion of your total treatment cost.
Orthodontic benefits rarely pay out in full up-front, so it’s essential to keep your plan active for the duration of your treatment. Depending on your insurance company, payments are spread out during treatment in monthly, quarterly, or yearly installments.
The start date is when you get your braces or have appliances placed for your teeth. Your insurance will need this information to process your claim.
Loss In Coverage
If you have a loss or lapse in coverage, any remaining balance will be the account holder’s responsibility. We’ll always be here to answer any questions and help you manage your account.
Work In Progress
Please inform our office immediately of any new coverage so we can submit a claim promptly. It’s common for your new insurance company to prorate your benefit based on the prior coverage paid or remaining treatment time. Not all plans cover work in progress, so contact your provider to learn if you have this benefit.
Dual Coverage / Primary & Secondary Insurance
Double coverage is when you have two active policies. Our office will do our best to help determine how much each policy should pay. Some exclusions may be present on your policy, making it impossible to collect on both, known as a “non-duplication” rule.
If you need extractions or exposures during your treatment, please note that those procedures are often billed from a dental benefit, but in rare instances, they will be billed from your orthodontic benefit. In this instance, our office will not receive the full anticipated benefit and will transfer the remaining balance to your account.
What to Consider When Looking at Your Insurance Plan
It can be confusing sifting through all the information to determine what you need to know. Here are some helpful questions to remember when reviewing your dental insurance plan to be sure you’re getting the most.
- What are the lifetime maximum benefit limits?
- Does coverage apply to adults, children, or both?
- Is there a waiting period before coverage can begin?
- If treatment has begun before the plan starts, will it still be covered after the waiting period? Are there any restrictions?
- Are any types of braces not covered?
- Are there any restrictions on orthodontists? For example, do they have to be within a specific health network?
- Is there a deductible for orthodontic work?
How to Determine If You Have Orthodontic Benefits
All dental insurance plans are different and will offer unique benefits, so it’s important to understand your policy thoroughly. To determine if you have orthodontic benefits, check under the dental section of your benefits breakdown or reach out to your HR or benefits specialist.
If you have a spouse with dental coverage, you should check to see if you’re covered under their plan. You can sometimes combine your benefits to get more coverage and reduce your out-of-pocket expenses.
Maximize Your Orthodontic Coverage with Dietrich Orthodontics
Here at Dietrich Orthodontics, we’re committed to helping you make the most of your treatment—including the financial aspect! You’ll work directly with Dr. Dietrich and our team every step of the way as you transform your smile. We’ll file your claims and help you fully understand your insurance coverage before starting treatment to ensure the best results for the best cost.