Confused about your orthodontic insurance? We’re here to help!
There are many misconceptions when it comes to orthodontic insurance. We have listed below some statements that will hopefully help you understand orthodontic insurance and how insurance companies pay those benefits.
- Orthodontic treatment is nearly always a lifetime benefit and does not renew yearly. It is usually separate from the dental benefit but may include some oral surgery procedures.
- The orthodontic insurance benefit is commonly a set dollar amount paid at a certain percentage. The insurance will pay for the percentage of treatment up to the lifetime maximum dollar amount — whichever is less. For example, if your lifetime benefit is $1500 at 50 percent and your treatment fee is $1000, it will pay 50 percent or $500. But if your treatment fee is $3000 or more, no matter how high the fee, the maximum you will receive is $1500.
- Nearly all insurance companies will make an initial payment when the appliances are placed and then make payments over the length of treatment. (Payments are made monthly, quarterly, semi-annually or even annually. Frequency of payments are at the discretion of the insurance company, not our orthodontic office.) Insurance companies rarely pay Igel Orthodontics in full at the start of treatment. They do this because the adjustment visits are not performed all at once. This means that if you lose or cancel your insurance before treatment is finished, or before your insurance is finished paying, you will likely lose a portion of your benefit. Always check with our office before cancelling your insurance so we can advise you on your insurance balance.
- Some orthodontic benefits have a longer waiting period. Although you may have met the wait period for general dental benefits, you may have to wait six to 12 months longer before your orthodontic insurance benefit will begin making payments.
- If you have two orthodontic insurances, there is a coordination of benefits that has to be checked to see how the benefits will work together. Usually the birthday rule applies, meaning the insurance of the individual whose birthday comes earlier in the year will be the primary insurance. If you are lucky, they will coordinate, and you will get the full benefit from both insurance companies. If they don’t, you will only receive the benefit of one.
Because many insurance policies vary, we offer a complimentary insurance benefits check at your consultation appointment.
Keep in mind, insurance verification is an estimate of benefits, not a guarantee of payment. To help us with your insurance filing, please include your insurance information when completing the online Patient Information Form. We welcome you to contact our office at (402) 330-1152 today for more information and to set up an appointment with Dr. Igel or Dr. Chartrand, our orthodontists in Omaha, Nebraska.
** Note ** We accept most insurance plans and will gladly file insurance for you; however, please note we are not a provider for Medicaid.