How does orthodontic insurance work?

There are many different agreements between insurance carriers and their subscribers, and each contract provides a different benefit.  Orthodontic insurance, however, generally differs from regular dental insurance in that each insured member or the family usually has a lifetime maximum benefit for orthodontic services.  There are often age limitations.  This benefit is paid as a percentage of the orthodontic fee (diagnostic records, initial fee, monthly payments, etc.) until the benefit maximum has been reached.

How does our office assist with insurance?

At the initial examination we will provide you with an estimate of your insurance benefits.  For your convenience, we will gladly assist you in submitting insurance claims relating to charges for care rendered in our office.  Please be advised, however, that our primary financial relationship is with our patients or their families and not with their respective insurance companies.  Final responsibility for collection of insurance benefits rests with the insured party.  Our professional services are rendered and charged directly to the patient or their family, and they are responsible for payment of all fees incurred.

Practice Accepts Assignment of Benefits

Professional Fee=Patient Account

Less Estimated Ins. Benefit paid directly to office

Equals Patient Account Balance paid based on financial agreement

The following guidelines are advised

Each patient is encouraged to know what the benefits are before treatment starts.  If you are not sure, contact your insurance company so that you will know exactly how much you can expect to be paid and when to expect payment.  We would be glad to assist you in obtaining this information.  We ask that you provide us with the name, address and telephone number of your insurance carrier as well as a copy of your card with all the appropriate information.  We cannot render services on the assumption that our charges will be paid by an insurance carrier.  You may, however, endorse your insurance payments to our office.  We will be happy to credit these to your “insurance” account.  If your company notifies you that it requires verification of continuing treatment, please let us know and we will make appropriate arrangements to forward that information to your insurer.  If your insurance carrier provides a form for verification of continuing treatment we will be glad to complete it.  If they do not, we will generate one as necessary.  If in the event you or your employer terminates the insurance during the course of treatment, you will be responsible for all remaining unpaid fees.  Please do not hesitate to discuss any questions you have in regards to this.

 

CareSource and Molina Information

Our office is thrilled to extend our incredible services to those requiring care through state agency support, including CareSource and Molina. This is required for a professional practice, and required of us as people and professionals. We hope to have you contact our office if you are currently enrolled in either of these agencies. (Please note age limitations exist)

 

Our Office Accepts the Majority of PPO and HMO Orthodontic Insurance Plans

Our office accepts a majority of insurance plans so that we collect directly from the insurance company on your behalf. Since we feel most children and adults can benefit from orthodontic care we work closely with all insurance companies to get the maximum amount of benefit for our patients. Many other orthodontic offices will not accept orthodontic insurance and the patient becomes responsible for collecting the insurance money from the insurance company. Then there are some orthodontic offices that technically “accept” insurance but they are not an actual participating provider with that insurance company. When that is the case, the patient will not receive the maximum benefit from their insurance plan and may not get the best fee and the maximum coverage. As providers on most plans this allows our patients to receive the highest level of service and treatment at the most affordable treatment fee.