Dental Insurance for Orthodontics
We are a participating provider with all major insurance plans.
That means we do more than just accept your benefits. Insurance plan subscribers receive lower contracted fees as well as applied benefits, minimizing their out of pocket responsibility.
Call us if you have any questions about orthodontic insurance or if you would like us to verify your coverage.
Important details about insurance coverage for braces, Invisalign or other orthodontic treatment.
- Lifetime Maximum: This is the total dollar amount that your insurance company will pay toward treatment.
- % payout: Typically, insurance companies will only pay a % of the total fee (often 50%), and the Lifetime Maximum will go toward this amount.
- Waiting period: Sometimes there is a waiting period from the time you obtain Dental Insurance until the time when you can begin utilizing your orthodontic benefits.
- Age Limits: There may be age limits on orthodontic benefits, sometimes restricting coverage to dependent children.
- Dual-coverage clause: If you and your spouse both have dental insurance, it is important to know if the secondary insurance will allow for dual coverage. That means you may be able to take advantage of both benefits. We are happy to verify this for you.
- Maintaining coverage: As a policy holder, you must maintain your dental insurance throughout the entire orthodontic treatment plan in order to receive benefits. If you change plans or lose coverage, you will be responsible for the balance no longer paid out by the insurance plan.
Frequently Asked Questions
How does dental insurance work toward Orthodontics?
Typically, insurance plans pay up to a % of the total fee (often 50%, but plans vary). The plan’s lifetime maximum benefit will be used toward this payment. Patients are then responsible for the balance between the insurance payments and our contracted rate.
I don't have dental insurance. Can I still come in for a consultation and treatment?
Absolutely! Our consultations are complimentary. Further, we want to make orthodontic treatment obtainable for all our patients. You may be surprised how affordable orthodontic treatment can be. Most patients choose to make installment payments over the duration of their treatment, which in most cases is 18 to 24 months, at 0% interest. At your consultation, we will discuss your preliminary treatment plan and provide a quote for treatment. If after that appointment you have financial questions, call to speak with our financial coordinator. She can help you come up with a plan that fits your needs.
I don't have dental insurance. Can you suggest a plan I can purchase as an individual?
We suggest contacting your employer or an insurance broker. However, keep in mind you have to keep insurance plans active for the entire duration of treatment in order to receive the full life-time maximum. The most common lifetime maximum benefit we see is $1,500. If two years of an insurance premium will cost you less than the benefit, it may be worth getting coverage.
My wife and I both have dental insurance. How is it determined whose insurance is primary and whose is secondary?
When you are covered by two dental plans, this is called “dual coverage.” If you are the patient, your insurance is primary and your spouse’s is secondary. In the case of dependent children, insurance companies go by the birth date rule, that being, the person whose birth day and birth month are first in the calendar year (regardless of birth year), is primary. The other parent is secondary. There are exceptions, such as in the case of court-orders as related to divorced parents, step-parents and dependent children.
My wife and I both have dental insurance. We would like to use both our insurance plans for our child’s orthodontic treatment. Can we get the full lifetime maximum for both plans?
Possibly. We will look into both plans to find out if dual coverage is possible. There are many variables such as the plan’s lifetime maximums, the percentage coverage, the age limits of the plans and most importantly if there is STANDARD COORDINATION OF BENEFITS.
What is a non-duplication of benefits clause?
Some insurance plans have this clause in their policy to indicate that the secondary plan will not pay any benefits if the primary plan paid the same or more than the secondary would have paid if it was a stand-alone plan.
You are not a member of my insurance plan. How will this affect my treatment fees and out-of-pocket expenses?
At All-Star Orthodontics, we strive to be a participating provider in all major insurance plans to make orthodontic treatment accessible and affordable for our patients. If we do not participate with your plan, we can still file as out of network and you can utilize your benefits. Often there is no difference between in and out-of-network insurance contributions with specialized dental treatment like Orthodontics. We are happy to check your insurance benefits for you.
What happens if my employer changes insurance carriers?
Please let us know ASAP if your employer changes insurance carriers. Typically, this has no effect, positive or negative, to your insurance benefits; HOWEVER, the new carrier’s policy may be written differently and there may be a higher or lower lifetime maximum for orthodontics. There may also be an age limit difference. The best thing to do is check with your human resources representative as soon as you know the change is going to occur, to familiarize yourself with the benefits changes, if any. Once you are covered by the new plan, call our financial coordinator to update your benefits. She can let you know if there will any changes to your account as a result.
If my employer changes insurance carriers, will I now get to claim the new insurance plan’s full lifetime maximum?
No, there is typically a grandfather clause that simply picks up where the last policy left off and continues until the lifetime maximum has been met.
My child is in orthodontic treatment. I just changed employers. Will I get to collect the full lifetime maximum at my new employer?
If you change your employer during treatment, the current insurance will stop making payments once you terminate your employment/benefits. The new carrier, provided there is no waiting period and they have orthodontic benefits available within the age limits (if applicable) will pro-rate benefits and pick up where the previous plan left off. Unless the new orthodontic lifetime maximum is higher than the first, it is unlikely that you will collect any more benefits than originally estimated.
What happens if I leave my employer before the insurance lifetime maximum is reached and I do not have a new plan?
If you leave your employer before the insurance lifetime maximum is reached, no further
collections can be made against this insurance plan as you are no longer a member. You will be responsible for the balance.