Answering all of your orthodontic insurance questions

orthodontic insurance explained
Answering all of your orthodontic insurance questions
April 21, 2024

Let’s answer all of your Do you have a dental insurance policy with an orthodontic benefit, but you’re not really sure how it works?? Let us help by explaining how you can maximize your plan benefit to make treatment as affordable as possible!

1) Lifetime Maximum

Most dental insurance companies give you a lifetime maximum for orthodontics, This means that your insurance will pay out a set amount that you are able to use once in your lifetime. 

Once a claim is filed for your orthodontic treatment, and the full lifetime maximum is paid, you will not be able to file again to get a benefit. 

2) Insurance Policy Must Stay Active Throughout Treatment

An orthodontic claim is paid out over the course of treatment, not up front. Since orthodontic treatment requires multiple appointments that are spread over the course of months or years, your dental insurance company spreads their payments over the amount of time that you are in treatment. In order to get the full benefit from your insurance company, it is VERY important that your policy stay active over the entire course of treatment. Cancelling your insurance plan during treatment, going from an enhanced dental plan to a basic dental plan, and changing jobs during treatment could result in you losing your orthodontic insurance benefit. If you do lose your benefit, unfortunately the remaining balance that was supposed to be paid by insurance will be your responsibility.

3) Retreatment

Most dental plans will not pay for a patient that is being retreated. Even if you have a brand new dental policy in place, they likely will not pay since an orthodontic benefit is a lifetime benefit. 

4) Works in Progress, aka Getting an Orthodontic Benefit After Treatment Has Started

Not all dental plans cover works in progress for orthodontics. If you started orthodontic treatment and your insurance policy became active after your start date, your plan may not pay anything towards treatment. It is important to ask if the policy covers Works in Progress, if you are hoping to take advantage of an orthodontic benefit. 

5) Limited Treatment

If you need limited treatment, there is no guarantee that your full orthodontic benefit will be paid out. Dental insurance companies base their payments off of the treatment length. If a patient only needs to be in treatment for 12 months, the insurance company may not pay the same as if the patient were to be in treatment for 24 months. The only way to know exactly what your insurance company will pay is by having your orthodontic office file a pre-d! 

We work very hard to make sure that we are able to receive the maximum insurance benefit for our patients. If you are new to orthodontics and have questions about how your dental plan works, reach out to us here! Marie and the rest of our admin team are insurance experts!