Insurance coverage for orthodontics can be confusing. When it comes to treatment for you or your child, you'll want to have a firm grasp on whether or not you can expect help from your dental insurance to cover the cost. Each dental plan is different; some offer orthodontic benefits while others don't.
How will I know if my insurance plan has orthodontic benefits?
Since each plan is different, one way to know for sure what benefits you have is to call your dental insurance provider with the kind of treatment you're considering. They should be able to confirm whether or not it falls under your plan. If you're not sure about the kind of coverage you're entitled to, our team at GFO is here to assist you in finding out.
How much will insurance cover?
Orthodontic benefits are not like regular dental benefits. For orthodontics, insurance usually has a cap, or lifetime maximum. Essentially, once you've used these benefits, they will not be renewed. Depending on the policy, and whether or not you choose an in-network orthodontist, the insurance may cover your full cost or a portion of the cost of treatment. If you're undergoing an orthodontic treatment that is completed in multiple phases, the benefits that were used during the first phase may reduce the amount of coverage you can receive during the second phase.
How does insurance pay the benefit?
Orthodontic benefits work in several ways. Plans typically cover a certain percentage or amount of the treatment cost, with a cap (maximum) on how much they will cover for orthodontics. Most commonly, insurance will pay over the course of treatment in monthly installments. Some plans have a fixed co-pay - in these cases you would pay your co-pay and then the insurance company will pay the remaining balance over the course of treatment. A small number of insurance companies pay benefits in one lump payment. To receive your full benefit, your dental insurance plan must be active for the entire course of treatment. If you drop your dental/orthodontic insurance before your benefit has finished paying, this can result in more out of pocket expenses for you.
What if I get new insurance during treatment?
Some insurances have a "work in progress" policy that allows the new insurance to pick up coverage. In other cases, the new insurance may consider it an "existing condition" and may not cover. Calling your insurance company before switching is always a good idea.
Can I have dual coverage?
The answer in most cases is yes, but there are a few rules insurance companies follow when determining primary vs. secondary. You'll want to make sure your plan allows for standard coordination of benefits.
Does insurance cover clear aligners?
Most dental insurance plans cover treatment with clear aligners such as Invisalign in the same way they cover treatment with braces.
How much will my orthodontic treatment cost?
The cost of orthodontic treatment depends on several different factors, including:
Treatment/appliances needed
Complexity
Length of treatment
Our team will review the different factors that will affect the overall cost of care. We will also take the time to review your insurance benefits so that you know ahead of time what you can expect to pay out of pocket.
At Godley Family Orthodontics, we extend the extra courtesy to deal directly with your dental insurance provider. We verify and submit your insurance for you so that you do not have to deal with he hassle of filing insurance claims. If we expect insurance to cover a portion of your treatment, we will collect directly from them to reduce your monthly payment and make treatment more affordable.