Orthodontic Insurance Explained

Orthodontic Insurance Explained
April 6, 2021

Understanding insurance when it comes to orthodontics can be a little tricky, but don’t worry… it is not as complicated as it seems, and we are here to help! If you think that orthodontic treatment is in your or your child’s future, make sure that your dental insurance has an orthodontic benefit if you plan to file it. We can file insurance for both braces and Invisalign, so you have options!

There are several things to consider when choosing the insurance plan that is right for you. An orthodontic lifetime maximum is the amount that an insurance company will pay per person for individuals covered on the policy. Each covered individual gets a set amount for orthodontics, and once it is used, there are no additional orthodontic benefits. The lifetime maximum is paid over the course of treatment, not completely at the beginning. It is extremely important to keep your dental policy active throughout treatment in order to ensure that you receive your full orthodontic benefit.

There are many important things to understand about insurance, including treatment complexity, age limitations, deductibles, and if the plan covers “works in progress” (aka treatment has already started). The total amount that your insurance will pay depends upon your treatment plan and often the estimated treatment length. Although many dental policies cover adult orthodontics, some provide coverage for dependents only. Some policies also have deductibles that must be paid by the policyholder. If a policy becomes active after you or your child have started treatment because of a change of employment, etc, we are happy to file a new insurance claim for you. However, your plan must cover “works in progress” for you to receive any benefit from the insurance. Finally, we want you to know that most insurance companies will pay towards orthodontic treatment both in and out of network.

Our complimentary consultation includes verification of your insurance benefits, and then we will present you with your affordable treatment plan. We will let you know what your plan covers and answer any questions you have. We hope this post cleared up some of the confusing insurance rumors out there! If you still have questions, give us a call, send us an email, or text us! We look forward to seeing you soon!

Marie (office manager extraordinaire, financial coordinator expert)