Does dental insurance cover orthodontic treatment?
Orthodontic coverage is additional coverage to dental plans that an employer can
purchase for employees.
Insurance now is much more defined and less variable...much more like a contract
than it has been in the past. It makes no difference whether you are
seeking orthodontics for cosmetic treatment or a very significant bite problem...if the
coverage has not been purchased by your employer, you have no benefits.
The only exception is if the the need for treatment is the direct result
of an accident. In such a situation, it may be covered by medical or
dental plans that provide for accidents. The easiest way to determine if you have orthodontic coverage
is to call the toll free phone number on the back of most dental enrollment cards.
Their customer service can tell you what your coverage level is, if any.
If I do have coverage, how does it pay?
Again, this would be best determined with a phone call to the number on your
enrollment card. In general, most coverages pay a percentage of the fees
up to a lifetime maximum. Also, some require a one-time or an annual
deductible. It is a very complicated area that we sort out for you in
advance of sending you the case presentation materials which include a treatment
agreement outlining your payment responsibilities with the anticipated insurance
portion deducted.
What insurance plans are you involved with?
We are orthodontic
providers for Blue Cross & Blue Shield Dentacare and DentalBlue
plans. Delta Dental plans we are enrolled in include
DeanCare, Deltacare, Delta Dental Extra, Delta PPO & Delta Premiere. We are preferred providers for many other insurance
plans and all regular indemnity insurers as well such as Cigna, Aetna,
Metlife & Others. It is probably best to
give us a call if you are uncertain if we are a part of your insurance provider
network.
Can I use my Flex plan at work for orthodontic fees?
Most cafeteria plans allow for orthodontic fees providing it is not done
strictly for cosmetic purposes. We can provide a letter explaining the
nature of the treatment and will work with you to
determine the level of contribution that would best utilize your benefits in a given year.
Do you have financing options available for the
patient portion of the fee? We offer a
non-interest- bearing* payment plan through the office that roughly coincides
with the estimated length of treatment. It requires a down-payment of $1,100.00 and monthly payments of $125.00 for comprehensive
treatments and will be less for limited treatments. This is a base fee before the deduction of insurance. For instance,
if the insurance is 50%, you would pay half of those fees up to the benefit
maximum and then the balance would be your responsibility. As an alternative, there is a plan
approved by the American Association of Orthodontists, "Orthodontists'
Fee Plan", that allows for no
down-payment and lesser monthly payments over an extended period of time for
your portion of the fee.
Interest is factored into the payments at a rate determined by the length of
time selected to pay the fees. We can
supply the information and a toll free number to call to see if you qualify for
the plan and what payment arrangements can be made. Approvals are generally given over the phone the same
day from OFP. *Amounts that
become past-due on the office payment plan are assessed interest at 1.5% per month (18% per annum).
How are your fees billed and when is payment due?
There is a "catch-22" to this question. We do not know exactly how an insurance
company will pay on a given case until we send a pre-authorization but we need the diagnostic records
to properly assess the case needs and appropriate fees. We ask that
payment be made in full for the diagnostic records if insurance proceeds are
questionable. When the insurance
payment for the diagnostic records comes with the determination of benefits a credit
would appear on your account which would be credited against your out-of-pocket cost at the time the braces are
placed. These are the only two appointments where payment is expected the
day of service. The remainder of the fee will be billed as outlined in the
Treatment Agreement which you will receive approximately two weeks after the
diagnostic records have been taken along with the rest of the case presentation
documents. Billing is done on a monthly basis with a
pre-addressed return envelope provided for your convenience for payment of your
portion of the fee.
My ex-spouse is equally responsible for the
fees. Can you split the billing? We
have tried this in the past and have found it a very time consuming and
difficult situation. Our business is orthodontics and we cannot become
involved in family financial matters. With this in mind, only one parent
will be billed and it is usually the custodial
parent. We will, however, file claims on the patient's
behalf with an ex-spouse's or step-parent's insurance coverage and apply
the proceeds to the patients account.
TM
