All You Need to Know About Orthodontic Insurance

Orthodontic Insurance

Did you know that orthodontic coverage is often a separate benefit within your dental insurance contract? So how do you know if you have coverage? You can call your insurance company, or speak with the plan administrator and ask the following:

  1. Is there orthodontic coverage on the plan?
    If the answer is YES…
  2. What percentage is covered?
  3. What is the maximum (either annual or lifetime) benefit?
    Are there any limitations for the coverage (Age restrictions? Any deductible?)
  4. So… you have orthodontic coverage on your plan, and you begin your journey towards that Oscar winning smile with your orthodontic specialist; Now what?!

Submitting your orthodontic claims to your insurance company can sometimes seem complicated, especially because orthodontists do not accept assignment of payment from insurance companies like your general dentist, and because claims cannot be submitted electronically like most general dental practices can do.  While it is the obligation of your orthodontic office to provide you with a CAO or “predetermination” form, it is your obligation to submit your monthly claims to your insurance company for reimbursement.

Step 1: Upon deciding on a treatment plan and financial structure with your orthodontist, you must send a predetermination to your insurance company. Some orthodontic offices will do this on your behalf, if not they should provide you with the completed form.

FYI: The predetermination provides your insurance company with a brief description of your orthodontic condition, the treatment length, as well as the financial arrangement you have decided on.

2-3 weeks after mailing in the predetermination you should receive a response from your insurance company – if not, call them and make sure they have received it.

Step 2: As you receive your monthly receipts for your scheduled payments, you will send your claim along with the receipt to your insurance company (some companies even allow you to make your claim online!). Your insurance company will reimburse you directly.

It’s that easy!

 

In-Person Consultation

Use our handy online scheduler below to choose the date and time that works best for your initial complimentary consultation appointment!

Alternatively, please contact our office directly by phone/text if you are trying to book multiple consultations at the same time or are seeking consultation further out than 12 weeks.

Please note – If none of the available times on our online scheduler work for you we do have other consultation times available. Please contact us directly for more information.

Virtual Consultation

Skip the office visit and have your free consultation from the comfort of your home. The start to your beautiful smile is just a few photos and clicks away.

Virtual Consultation

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