dental insurance form

By Brenda Cooper Servi, Insurance Coordinator

For most Americans, one of the most important elements of any medical or dental decision is knowing how insurance works. So if you’re considering starting orthodontic treatment, you’re likely wondering how your insurance will come into play when helping you pay for treatment. Here are some answers to some of the most common questions about insurance and orthodontics.

Can I Use Dental Insurance for Orthodontic Treatment?

The short answer? Yes. In most circumstances, a standard dental insurance plan should help you pay for orthodontic treatment. The actual percentage of your orthodontic treatment that will be covered by your insurance company depends on the specific plan you have. Not all insurance plans are the same, so you could have a small portion covered or the majority of your treatment covered.

What if I Switch Policies During Treatment?

It’s generally recommended that you keep your policy for the whole course of your treatment to guarantee you receive your benefits. While dental insurance works for orthodontic treatment, the benefits are applied over time rather than all at once. This is because orthodontic treatment works in phases whereas most dental procedures are finished at once. If you transfer to a new policy midway through your treatment, your new policy may re-evaluate your treatment as “work in progress,” which typically leaves you with the remaining costs, unless the new insurance plan covers work in progress.

What Happens if I Have Two Insurance Plans?

The billing team at the orthodontic office will be in contact with both of the insurance companies that could potentially provide benefits for your orthodontic treatment. They will then let you know how each policy will pay for your orthodontic treatment, allowing you to make the best financial decision for yourself.

Can an Insurance Company Pay the Insured Directly?

Patients often wonder if an insurance company is required to send payments directly to the orthodontic office or if they can elect to have the insurance payments sent to them instead since they are the insured (the subscriber). This depends on the policy of the orthodontic office you choose. Many times the orthodontist is an in-network provider, which requires the insurance plan to pay the orthodontist directly unless the insured has already paid the entire treatment in full. If this is the case, the subscriber of the policy would get reimbursed after the fact.

What Is a Discounted Plan?

A discounted plan works different than a conventional health/dental insurance plan. These plans offer a flat percentage off treatments for specific doctors who have partnered with them. It’s a good option because patients don’t have to wait for insurance to pay. You’ll need to keep this insurance plan during the entire course of your treatment to receive the benefits.

What if I Lose my Insurance Partway Through Treatment?

If this were to happen, you would lose any benefits that have not been paid to the office. While this may be distressing, if this were to happen, you can arrange a new payment plan that works for your budget by choosing new repayment terms.

Here at Charleston Orthodontic Specialists, we will help you find a payment plan that works for you. We’ll advocate to your insurance company on your behalf as much as possible to maximize your coverage, and should the worst-case scenario happen and your coverage gets canceled, we’ll do what we can to make your treatment affordable for you.

Contact Charleston Orthodontic Specialists today to schedule your free consultation and to learn more about paying for braces.