How Does Orthodontic Insurance Work?

Getting started with braces or Invisalign treatment can come with many questions, and one of the most common is, “How does orthodontic insurance work?” Fortunately, our team of experts is here to guide you through the process and show you how Chamberlain Family Orthodontics can help you maximize your orthodontic insurance benefits. 

How does orthodontic insurance work? 

Your total treatment cost is divided into three parts: 1) the amount your orthodontic insurance policy is estimated to cover, 2) your initial payment, and 3) your monthly payments. And while the intention of your policy is to help you pay for treatment, orthodontic insurance works a bit differently than other forms of medical and dental insurance. 

Orthodontic insurance companies typically consider braces or Invisalign treatment to be a single procedure spread out over several months or years, as opposed to a series of separate procedures that occur at regular intervals. However, insurance companies rarely pay their portion in one lump sum. Instead, companies usually pay in monthly installments similar to your own payment plan. This is especially important to keep in mind if you lose coverage or change insurance policies, which we will cover later. 

Key Orthodontic Insurance Terms You Should Know

Tackling the question of insurance benefits can be a complex process because there are multiple moving parts at play. It’s important to understand several key terms when navigating the world of orthodontic insurance so you’re aware of the ins and outs of your policy. 

Lifetime Maximum

Most orthodontic insurance companies have a lifetime maximum coverage policy, which means that they will cover a percentage of the treatment cost up to a limited amount. These benefits are not intended to cover the full cost of treatment. Instead, they’re meant to help offset the out-of-pocket cost at the beginning of your contract.  

Coordination of Benefits

It is not uncommon for patients to have more than one insurance policy covering orthodontic treatment. Coordination of benefits refers to the way multiple insurance policies work together to cover treatment. Policies with standard coordination are typically additive, meaning you should receive benefits from both!

Work-In-Progress Benefits

Sometimes, patients and their families change orthodontic insurance companies in the middle of treatment. While we advise against changing policies until your benefits have been paid out when possible, these changes are often out of the patient’s control. If this happens, our team can help you file for work-in-progress benefits through your new policy. 

How Does Orthodontic Insurance Work?

Here’s How We Can Help

Understanding the network of orthodontic insurance paperwork and terminology can be difficult, but our team is dedicated to helping you maximize your benefits to reduce your total cost. Here’s how we can help. 

Filing Insurance Claims

At Chamberlain Family Orthodontics, we employ a team of insurance specialists to help file initial claims, work-in-progress claims, disputes, appeals, preauthorizations, and the like so that you don’t have to. This takes much of the weight off your shoulders so that you can focus on the most important thing: your or your child’s smile. 

Submitting Adjunct Claims

Our team of orthodontic insurance specialists typically submits claims for adjunct services (like diagnostic records and habit therapy) to reduce your out-of-pocket cost. This method can help in one of two ways. 

Stretch the Lifetime Maximum

Some orthodontic insurance policies count supplemental orthodontic claims as separate from the lifetime maximum allowance. By filing for them separately, the benefit payments won’t be deducted from your lifetime maximum, which will help stretch your coverage further. 

Simultaneous Payments Reduce Loss of Unused Benefits

Even if benefit payments for adjunctive services are included in your lifetime maximum allowance, filing separately means that your insurance company will make extra payments in addition to the standard installments for orthodontic treatment. This means the lifetime maximum is paid out more quickly, which would reduce the financial burden if you lost or changed your orthodontic insurance policy mid-treatment. 

Assignment of Benefits

In some cases, insurance companies default to reimbursing the subscriber rather than making direct payments to the provider. However, by assigning the benefits directly to Chamberlain Family Orthodontics, we can cut out the middleman and reduce your total treatment cost. By separating out the estimated insurance benefits, we’re able to make your payment plan much more affordable!  

How Does Orthodontic Insurance Work?

Making Your Treatment Experience Easier, One Claim at a Time

Although becoming familiar with your orthodontic insurance policy can be a complicated process, you’re not alone. The Chamberlain Family Orthodontics team is dedicated to helping you and your family maximize your benefits and minimize your stress so you feel comfortable with the treatment process and look forward to your results. If you have any questions about payment options or if you want to get started with treatment, call our office in Redlands or Beaumont today!