Frequently asked Insurance Questions

Q: Does insurance pay the lifetime maximum in one lump sum?
A: Orthodontic benefits are paid out, generally, over a period of treatment or until the maximum benefit is met.

Q: Can I expect benefits on my adult children?
A: Orthodontic benefits generally pay only up to a patient's 19th birthday. In rare cases coverage continues when registered as a full time student.

Q: Can orthodontic treatment be considered medical and filed under medical coverage?
A: No, once something is cemented in the mouth it becomes dental in nature. Unless, it is accident related, it could then fall under either medical or dental, depending on the accident clause.

Q: Is TMJ a covered benefit?
A: If treated with a removable appliance such as a splint, it is covered more often under your medical insurance. If treated with braces, medical plans will exclude it. They pay about 50% of usual and customary fees after your deductible is satisfied.

Q: Can insurance benefits be assigned to your office?
A: In most cases we are able to accept insurance assignment. Some insurance companies, however, will not pay directly to out of state providers. In this event, we will be happy to file your insurance and assist you in getting benefits payable to you.

Q: Can the insurance be considered my down payment?
A: No, insurance is handled completely different and is separate from any initial payment required.

Q: Is there a difference between insurance and medical reimbursement?
A: A huge difference. Insurance is a benefit payable to either you or the provider for services rendered. Medical reimbursement is just that, reimbursement for medical expenses paid by you, but not covered by any insurance policy. Medical reimbursement is governed by the IRS and strict guidelines must be followed.

Q: What do my orthodontic benefits cover?
A: Orthodontic appliances. In some cases habit breaking appliances and space maintainers may not be covered. As a courtesy to our patients, we will verify your benefits and advise you as accurately as possible any benefits you may have.

Q: My benefits will terminate soon, can I hurry and have my daughter's braces put on before the benefits stop?
A: Since most ortho benefits are paid over the course of treatment as services are rendered, you will not be able to obtain your full benefit if your insurance terminates shortly after starting treatment. Orthodontic services are rendered month after month, therefore monthly insurance payments will terminate when the policy ceases.

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