Misalignment, jaw problems or crooked teeth are a problem for many people around the country. It is estimated that over 4 million people are wearing braces in US, but the number of those in need of such corrections is certainly higher. The costs of orthodontic treatment is rather high, therefore not many people afford such procedures. For example, the traditional braces for children range between $1,000 and $2,000, while for adults the price can go up until $5,000. In these cases the orthodontic insurance is a necessity and while most people believe orthodontic treatments are covered by the general health insurance, there are many companies which do not cover such procedures in standard packages. Therefore a specialized insurance plan is recommended, so that the costs become more bearable. But what it is an orthodontic insurance, how does it function and what are its main particularities?
How does the Orthodontic Insurance function?
This specialized health insurance functions similarly to any other health insurance. A fix, pre-established sum of money is paid every month to an insurance provider. When the client needs to undergo an orthodontic treatment, he/she claims the insurance. The insurance covers the treatment or part of it, depending on the treatment’s cost and on the orthodontic plan contracted by the client. In order to receive the granted benefits, the client must take some steps, which are detailed below.
Generally, there is a waiting period before you can claim the insurance. In most cases this waiting period is one year after the contract is signed. After this time the client not only is able to claim the insurance, but also starts to benefit from other facilities, such as an increase in the available sum. For example, a plan which starts with an available sum of $500 will double its value in four years if every year an extra $200 is added to the available sum. In order to benefit from the extra sum, the client must remain faithful to the company and not to claim its insurance in the given period. The available sum grows year by year, until a maximum is reached. This maximum amount will be preserved throughout the years, until the patient claims the insurance. This is mainly a strategy for the insurance companies to keep their clients. Some other companies offer the maximum sum from the first year of contract.
Generally the insurance covers the pre-orthodontic visit, the examination and start-up records and the orthodontic treatment itself. The orthodontic retention and the post-treatment records are also included in most insurance plans.
Depending on the chosen plan, there are certain restrictions to what orthodontic treatments and procedures are covered by the insurance. Appliances to correct thumb sucking and other harmful habits, invisible braces such as Invisalign and jaw surgeries are only covered by premium insurance plans.
Orthodontic Insurance vs. Orthodontic Discount Plan
The orthodontic insurance functions similarly to any health insurance (as detailed above). There are limitations to the treatments and conditions it can cover and, depending on the chosen plan, there are additional sums of money to be paid (co-pay) for some of the orthodontic services.
The orthodontic discount plan offers a discount from the initial price of the treatment. In order to benefit from the discount, the client must sign a contract with the orthodontic discount plan provider and pay a monthly fee, significantly lower than the one charged by the insurance. The discount plan does not have a limit for its benefits and it is applicable for small as well as for long and costly treatments. Furthermore, there are companies which have designed discount plans for families or households, which are much more affordable than the individual plans. One of the well-known discount plans is AmeriPlan Dental Plus, which offers different discounts in accordance with the treatment to be done. EDP’s Dental Plan offers 25% discount for braces and additional treatment when the mounting date is posterior to the contract date. Humana offers both discount plans and insurance plans adapted to individual or family needs.
The discounts are done on the spot, without the need of a 30 to 60 days waiting period, as it happens with the orthodontic insurance. The client can choose whatever orthodontist they prefer and still benefit from the discount, while special benefits are offered when choosing one of the preferred professionals. For the remaining percentage of the cost, the orthodontist can devise a payment plan or recommend a credit card. One of the drawbacks associated with these plans is that they do not offer discounts for treatments which have begun before the contract.
Steps to Take in Order to Benefit from Orthodontic Insurance
In order to benefit from this kind of insurance, most insurance companies require information on your condition as well as on the type of treatment recommended by the orthodontist. It is essential that the patient follows all the steps mentioned in the insurance contract before starting the treatment. In fact, the treatment should start only after the insurance company gives you the green light for the procedure. Below are the main steps which need to be taken in order to have access to your insurance policy.
Read the contract
It may seem obvious, but many people fail to read the insurance contract before looking for an orthodontist. Usually insurance companies have specific requirements, so carefully reading the terms may spare some time and money.
Find an orthodontist which is collaborating with your insurance company
Choosing the orthodontist based on friend recommendation is no longer an option when are working with an insurance company. While most companies will eventually accept a collaboration with an orthodontist outside their network, the co-pay may be higher or the procedures covered may be limited. On the other hand, choosing an orthodontist which collaborates with the insurance company bring you additional benefits like better rates, discounts, bonus procedures and smaller co-pay. Furthermore, the payment process will be smoother for all parts involved.
Ask for a Treatment Plan
The pre-treatment estimate must include a detailed account of the treatment, the date the braces were positioned (if already existent) or the date the procedure will be done and the American Dental Association code for the treatment to be done. The treatment plan must also state the estimate cost of the entire treatment as well as the number of months in which the patient will undergo treatment.
Some companies also require details about former interventions as well as about previous orthodontist insurances. Before submitting the plan it is advisable to talk to a company’s employer to be sure you have included all the necessary information.
Send the treatment plan for evaluation to the insurance company
The insurance company will evaluate the plan and give the client information on the procedures which can be covered, the amount of money you need to co-pay as well as other specific informations related to your insurance plan. Based on this evaluation you can decide if you are able to go on with the treatment or you will postpone it until you have all the necessary funds. If the chosen orthodontist is part of the preferred professionals of your insurance company, then he/she will submit the pre-treatment evaluation for you, so that you are saved of all the hustle. One of the companies offering this type of service is Delta Dental plans.
Insurance for pre-existent treatment
Orthodontic treatments take more than one or two sessions in a month. For proper results, most treatments take months or even years. There are times when the insurance contract is no longer valid or your company decides to collaborate with another insurance provider. This leaves you uncovered, as most of the dental insurance companies refuse to take over treatments which have started before the contract. This is why it is essential to maintain the same insurance company throughout the treatment.
There are some cases in which the insurance company may cover a pre-existent treatment. For example, Aetna Dental plan will cover pre-existent treatments if the client who requests coverage is working in a company which currently switched from a different insurance company to Aetna. However, if the client has a new job at a company working with Aetna and the pre-existent treatment has been started when working for another company which did not use Aetna as an insurance provider, the client will not be covered for that existent treatment.
It is important to note that no insurance company will cover or refund procedures which have been completed before signing a dental insurance with them. Therefore only think of yours and your family’s future needs when choosing the dental plan.
Companies offer their employees’ health, dental or orthodontist insurances. However, the competition between insurance carriers is rather harsh and new, more attractive proposals are made every month. Therefore companies tend to switch from one carrier to another in search of the best option for their employees and for their budget. If you benefit from such an insurance from your company, make sure you know all its advantages and downfalls before claiming it. Also, inquire about the possibility of switching to another provider during the time of your treatment, since most carriers do not pay for pre-existent treatments and you will be left to deal with the remaining payment. Similarly, if you plan to change jobs before the treatment is completed, make sure you have enough money to cover the remaining costs.
Ways to cut-off expensed when using an orthodontic insurance
There are rare cases in which the insurance covers all the orthodontic expenses. Whether you are using a traditional insurance or a dental discount plan, there are always different ways to cut off the treatment expenses. Here are some of the methods which are worth giving a shot:
Discounts for upfront payments
When using a dental discount plan you can get an extra discount from the orthodontist if you pay the entire treatment beforehand. Many dental offices have such offers, so make sure you enquire about it before making your mind on the payment method.
Discounts for other members of the family which get treatment at the same time
It is known that group insurances are much more convenient than individual plans. However, what it is not known is that members of the same family undergoing treatment in the same office or at the same orthodontist may benefit from discounts. If you and other members of the family need orthodontic treatment, it is advisable to synchronize and visit the same office for a quote. You may save some good money on your treatments.
As mentioned previously, most insurance companies work with different dentists and orthodontists, so try to find a list of the preferred professionals and choose one from there. This will add up benefits in your favor and may even lower your final bill. If your favorite orthodontist is not on the list, check with your insurance consultant the terms and the benefits you can obtain before making a decision.
Classic treatments instead of newest technology
New technology is more effective, but also more expensive. If in other domains going for the newest inventions is recommended, when looking for affordable braces, choose traditional over Invisalign. The wire braces are more visible, but they are as effective as the invisible option and are half (or even less) their price.
Orthodontic treatment provided by dentists
There are orthodontic treatments which can be performed in the dental office, by qualified dentists. Usually, the treatments done by dentists have a lower price than the ones performed by orthodontists. The dental and orthodontic insurances cover this type of procedures too, so you will be able to spare some money and even get a total cover for the same orthodontic treatment done in the dental office.
“Lifetime Limit” and “Age Limitation”
Dental and health insurances have an “annual limit” which means that there is a certain sum which is covered by the insurance. All other treatments which surpass this sum must be paid by the patient. Orthodontist insurance, on the other hand, has a “lifetime limit” which states that the client’s benefits will not re-accrue annually. Instead, the client can only benefit from the insured sum once in a lifetime for orthodontic treatments. All orthodontic procedures which are costlier than the imposed limit will be supported by the client.
The “age limitation” refers to the age limit until a client can benefit from insurance. Some insurance carriers refuse to cover orthodontic treatments for third generation persons, so it is important to discuss the age limit with your company before signing the contract. Also, the “age limitation” may refer to children who have reached a certain age and therefore are no long eligible for free/partially covered orthodontic treatment. The company will not even cover the existing treatment if the child has reached the age limit. The age limitation is different from one company to another, so this aspect will need to be checked with the insurance representative.
The orthodontic insurance is a necessary contract when suffering from crooked teeth, misalignment or jaw issues. Group insurances are always the best chance, so even if your workplace does not offer such an insurance, gather your family (and even friends) for a better deal. Before signing the contract, make sure all the problems are covered by the insurance and no unnecessary treatment is included (unless it does not affect the overall cost). But most importantly, choose wisely and read the contract again before claiming your insurance. It will save you lots of money!