What You Need to Know
You pay for dental insurance to help cover the cost of your orthodontic care. But not every practice interacts with insurance in the same way. At Adirondack Orthodontics, we believe patients deserve to understand the difference between a participating (in-network) provider and a practice that only says it “accepts” or “works with” your insurance.
What It Means to Be a Participating Provider
A participating—or in-network—provider has a formal contract with your insurance company. That contract sets clear expectations for:
* Pre-Negotiated Fees – The cost of treatment is agreed upon in advance, so you know your coverage and out-of-pocket amount before you begin.
* Direct Billing & Claims – The provider files claims and handles all paperwork from start to finish.
* Maximized Benefits – Because fees are set by the insurance agreement, you receive the full value of your plan without hidden surprises.
This is how we operate at Adirondack Orthodontics. As the largest orthodontic practice in the Capital Region, we participate with most major insurance plans and negotiate favorable rates on behalf of our patients.
What “We Accept Your Insurance” Really Means
Some practices advertise that they “accept” or “work with” your insurance—but that does not always mean they are in network. In these situations:
* No Pre-Set Fees – The office sets its own charges, which may be higher than the insurer’s allowance.
* Balance Billing – Your insurance will reimburse up to its limit, and you are responsible for the difference between that amount and the office’s usual fee.
* Paperwork on You – Patients are often required to submit claims and follow up with the insurance company themselves, a process that can be time-consuming and frustrating.
Our Commitment—Even If We’re Not In Network
Occasionally, we meet patients whose plan does not list us as a participating provider. Here’s what happens if that’s the case:
* We Still Work With Your Insurance – Our team will prepare and submit all claims on your behalf.
* You Still Benefit From Our Lower Standard Fees – Because we participate with most plans, our standard fees remain competitive and often lower than offices that are out of network entirely.
* Clear, Up-Front Costs – We explain exactly how your plan will reimburse and what your estimated responsibility will be—before you start treatment.
Why This Matters to You
Choosing an in-network orthodontic provider means:
* Predictable Costs – Your fees and coverage are agreed upon in advance.
* Less Stress – We handle all the communication and claims with your insurance company.
* Maximum Value – You get the full benefit of the insurance you pay for each month.
Even if your plan doesn’t include us in its network, you’ll still receive the same high-quality care and the same support navigating your benefits.
Ready to Learn More?
Your initial consultation is always complimentary and includes:
* Complete diagnostic records and X-rays
* An iTero® digital scan with a 3D smile simulation
* A detailed review of treatment options, insurance benefits, and cost
Call, text, or schedule online today to find out how we can help you get the most from your insurance—and start your journey to a confident smile with no surprises.