Understanding Your Orthodontic Benefits
Key Questions to Ask Your Insurance Provider
When contacting your insurance provider, make sure to ask these specific questions:
- Waiting Period: Is there a waiting period before your benefits become eligible?
- Age Limits for Adult Orthodontics: Does your plan have an age limit for adult orthodontic benefits? Some plans cap these benefits at age 19.
- Maximum Orthodontic Benefit: What is the maximum amount your plan will cover for orthodontic treatment?
Simplifying the Process
At our office, we simplify the insurance verification process for you. Our team will:
- Verify Your Insurance Benefits:
- We send a new patient packet requesting all the necessary information.
- Our experienced team will call your insurance provider to gather all the details on your behalf.
- Submit a Claim:
- Once you begin orthodontic treatment, we will submit a dental claim to your insurance company.
- We follow up to ensure the benefit is received.
- You may receive a check directly from your insurance company. When you receive this check, please notify our office so we can credit it to your account once payment is received.
Percentages Covered and Lifetime Maximums
Most insurance companies have a “once and done” policy. After you’ve received your full benefit, no additional orthodontic benefits will be provided. For example, if you received your full insurance benefit during Phase I treatment, your insurance may not cover Phase II.
Understanding Percentages Covered
Insurance companies typically cover around 50% of orthodontic treatment costs, but this can vary. The covered percentage usually applies unless the treatment cost exceeds your lifetime maximum.
For example:
- If you have a $1,500 benefit and the total treatment cost is $4,500, your insurance will pay the full $1,500.
- If the treatment costs only $2,000, your insurance will pay $1,000.
In most comprehensive cases, our patients receive full insurance benefits, though individual variations do occur.
By understanding your orthodontic benefits and working with our office, you can make orthodontic treatment, whether Invisalign or braces, more affordable. For more information on making orthodontic treatment affordable, please visit our Making It Affordable page.
Contact us today to get started on your journey to a healthier, more confident smile.
Ready to begin your orthodontic journey? Contact us today for a consultation,, and we’re here to help you make your braces or Invisalign fun and affordable!
Visit us at Porter Ranch Orthodontists for personalized orthodontic care. We listen to our clients and provide the best possible treatment to give you the smile you deserve. Book your appointment today!
