Orthodontic Insurance 101
Fast Facts About Orthodontic Insurance Coverage:
Orthodontic benefits are not covered by all dental plans. Orthodontic coverage is something you opt into as an added benefit.
Lifetime Maximums are specific to your insurance company or plan. If you switch insurance companies or plans and opt into orthodontic coverage on your new plan, you may have a new lifetime maximum that you can use.
Percentage covered does not mean percentage of the total treatment. Insurance companies use a formula to calculate coverage.
How Can I check to See If I have Orthodontic Coverage?
Orthodontic coverage varies from patient to patient. Since coverage is specific to your plan, the best way to check your coverage is to call your dental insurance company directly. You can typically find the customer service phone number on the back of your insurance card.
Here are a few questions to ask your insurance company:
What is (patient’s) orthodontic lifetime maximum (LTM)?
How much of this lifetime maximum is available?
Is there an age limit for benefits?
How much is initially paid out at the time braces are put on?
What percentage is orthodontic treatment paid at?
I will be accepting assignment of benefits. How will I receive these payments for covered services from the insurance company?
How is coverage paid out – Monthly? Quarterly? Annually?
Where Can I Find My Dental Insurance Information?
This information can be found on your dental insurance card. If you do not have a physical dental card or are missing some of the listed information, please call your dental insurance company to collect the missing information. We will then use this information to submit all of your claims to your insurance company!
How can i take advantage of my orthodontic benefits?
Using your benefits is easy. When you schedule your initial appointment with Foundations Orthodontics, you will receive an insurance questionnaire. Please complete the insurance questionnaire and our office will take it from there!
Orthodontic insurance terms defined:
Orthodontic Lifetime Maximum (LTM): This is the total amount insurance will pay towards any orthodontic treatment. Orthodontics is different because this LTM acts as a piggy bank and does not replenish year to year. It is the total amount available for the duration of the insurance plan.
Percent Covered At: This is the percentage used to calculate the maximum percentage of a treatment fee that an insurance company will pay for in relation to your orthodontic lifetime max. If you maximum “maxes” out before hitting the percentage, then you are able to use your full lifetime maximum but do not receive any additional payments from insurance.
Assignment of Benefits: This simply means who will be receiving payments from the insurance company. At Foundations, all our fees are calculated before insurance and payments are due according to the contracted amount. We then submit to insurance, and the insurance company pays the subscriber directly.
IB Fee/IB Percent Covered: This is how much money is due the day the braces are put on the patient. The percentage the insurance companies pay for IB fees may be different than the percentage they pay for the remaining balance of the total treatment fee.
Waiting Period: Some orthodontic plans require that patient wait a certain amount of time before they are able to use their benefits. One of the most common waiting periods is 12 months and these policies require 12 months of payments before a patient can use their benefit.
How will I know if my child is ready for treatment or if I need to sign up for orthodontic benefits?
The best way to determine if you child is ready for treatment is to schedule a complimentary initial exam. During this exam, Dr. Moran will let you know her findings and if your child is ready for braces or if you can wait a few years.