Welcome to the wonderful world of orthodontic insurance !  My name is Shelly and I am the Insurance Coordinator for our practice. Here are some answers to the most frequently asked questions.

Do I have to file my own insurance?

No, you don't. As a courtesy to our patients, I file all the claims and do the followup as well. 

How will my insurance company pay?

Most insurance companies make a down payment, then pay either quarterly or monthly over the course of treatment. Very few insurance companies pay the full amount at the start of treatment.

When will my insurance company get "billed"?

The day that you or your child has any material cemented to your teeth is considered your "start date". If you will be getting new orthodontic insurance it is sometimes worth the wait to hold off on treatment.  Our doctors can help you make that decision.

What happens if I lose my job or change companies?  

If you lose your job, then your ortho benefits will stop. It will be considered "terminated"on that day. It is the same if you change companies. Any balance that the insurance company did not pay will become your responsibility.  In either case,we will work with you any way we can to help you get  your balance paid in full. If your new employer offers ortho insurance, I will file for benefits as soon as you are eligible.

What is a "work in progress" clause?

A work in progress clause states that, if treatment has already begun, the patient is not eligible for benefits. This is something to watch for if you change jobs. You can ask your Human Resources person or it should be in your handbook. 

What happens if I get new insurance during treatment?

If you get new insurance during treatment, just let me know and I will get it verified and filed for you. In most cases you will not receive the down payment but you will receive the monthly payments from the effective date through your retention.

What if I have two insurances? Can I use both?

In most cases yes, you can. Insurance companies use the "birthday rule" which means they use the birthday that comes first in the calendar year. That becomes the primary insurance. The benefits from that insurance you will be sure to receive. The secondary insurance will pay at a certain percentage (usually 50%) up to the lifetime maximum.  If there is a "non-duplication clause" this means that the secondary insurance will not pay for duplicate benefits.

What is a lifetime max?

The lifetime max is the amount set by the insurance that is a one time benefit. It can range anywhere from $750.00 through $2500.00 and anywhere in between.  It is per family member usually through age 19 and up to age 23 if the patient is a full time student. Most adults are not coveraged under ortho insurance. You can find out through your Human Resources person or in your handbook.

Can I assume that if I have dental insurance that I will have ortho as well?

No, this sounds strange but your dental insurance and your ortho insurance are kept separate.

Can I use my insurance as my down payment or to pay my account?

No. Each responsible party has a separate account. Insurance proration is different and separate from the patient proration. 
 

These are the most popular questions that I am asked. I hope this helps you understand the workings of orthodontic insurance. It is completely different from any other insurance. Orthodontic insurance is a great benefit.

If you have any concerns or questions that I did not answer, please don't hesitate to give me a call. There is no question or situation that I haven't heard!

Thanks, Shelly
330-688-8667