A new year has begun and often times that coincides with a change in insurance, so we thought we would answer some frequently asked questions when it comes to orthodontic benefits.
What insurance covers braces? Typically orthodontic benefits are provided by a patient's dental insurance, but are independent of the benefits that cover fillings and cleanings. The only time there is a possibility of having coverage through a medical provider is if there is facial malformation that require braces to correct, like a person who was born with a cleft palate.
How can I know how much my plan will cover? This is a team effort between us and the insurance subscriber. Before any treatment is begun, our financial team always contacts your insurance personally to get the most thorough explanation of benefits possible. We always request a printed explanation of the plan, and check to see if there are any exclusions to benefits or pre-authorizations required before treatment begins. That being said, some insurance companies offer more help to a third party inquiring about benefits than others. There is not always a personal representative available to clarify unclear details and they will never guarantee benefits until the claim is submitted, so it is important to cross check the information we receive with the employees plan description. We try our best to estimate benefits with as much accuracy as possible, but it is always only an estimate.
Do I have to get a referral or a predetermination of benefits to have my braces covered by insurance? Usually not. The vast majority of orthodontic coverage is available without a referral from your general dentist. There are a handful of plans that require a referral, but we can help coordinate any required red tape before treatment is begun.
What are the benefits of going to an in-network provider for my braces? There are two main reasons: greater likelihood of familiarity with your individual plan and possibility of saving money on the cost of treatment.
When you go to an in-network provider, they often times have more insight into how your insurance company processes claims, than one that does not work with the company frequently. Although, there are many customizations available to dental plans in today's marketplace. Sometimes the true nature of your plan may be more complicated than who the face of the insurance is. For example, your insurance may be paid through Aetna, which we are a contracted provider for, but your plan may have specific limitations within the Aetna network of providers. As a bonus, in some situations your out of pocket cost may be reduced because of the contracted rates agreed upon by the provider and insurance company.
Does orthodontic insurance cover more treatment than standard braces? Yes! Insurance benefits can usually be applied toward Invisalign, retainers and several other orthodontic appliances.
What happens if my insurance changes during my orthodontic treatment? Since most orthodontic benefits are set up with a lifetime maximum, when you begin ongoing treatment, the insurance company will make incremental payments over the treatment length. Any changes to your plan during your time in treatment may change the total benefit paid. Any time you lose insurance, change policies, or get new insurance, please let us know so we can help you maximize your insurance benefits.
We hope all these tips are helpful, although it is only the tip of the iceburg. Please feel free to call us anytime you have questions.
