Dental Insurance FAQs

Your Insurance Questions, Answered

I have orthodontic coverage through my dental insurance. Does that mean I won’t pay anything out of pocket for my treatment?

Most dental insurances cover a set percentage of the total treatment fee, less any deductibles and up to a lifetime maximum amount, for orthodontic treatment. The patient is responsible for the portion of the treatment fee that is not paid by their insurance.

Does my insurance pay out the full amount all at once when I start treatment?

Very few insurance policies pay an up-front lump sum for orthodontic treatment. The majority of insurances make smaller payments regularly throughout the course of treatment. Some pay monthly, others quarterly, semi-annually, or annually. This is why it is important to maintain your coverage until your treatment is completed.

What are non-covered services?

Even if a policy includes orthodontic coverage, there are often services involved in orthodontic treatment that are not included in that coverage. When these services are provided, the patient is responsible for the full cost. Depending on the policy, these may include additional appliances, cosmetic upgrades, records, scans, retainers, and other services.

My insurance only covers orthodontics in cases of medical necessity. What does that mean?

When an insurance policy covers medically necessary orthodontics, they generally mean they will only pay out in cases where the patient experiences significant levels of pain or dysfunction in crucial activities such as eating or speaking, or in cases of serious structural deformity or damage. It can be very difficult to have treatment approved as medically necessary.

What happens if I am covered under more than one policy?

If you have secondary insurance, we will make your contract according to our best estimate of what your primary insurance will pay. We do this because there is no way for us to reliably estimate what a secondary insurance might pay.

The process of determining what your secondary insurance will pay can take 3-4 months from the start of treatment to complete. It is required that you make payments according to your contract until we receive payment from the secondary insurance. If your secondary pays out so much that you have an overpayment, you will be issued a refund.

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