How the Insurer, the Insured, and the Orthodontist View Orthodontic Insurance

Like many things having to do with insurance claims and coverage, orthodontic billing can be confusing, for patients, orthodontists, and insurance companies. However, like all types of insurance, it should be fairly simple if you break it down to its basics.

The View of Orthodontists From the Insurance Company

Most of us don’t really care what the insurance company thinks, but we should. Insurance companies wield plenty of power (and make plenty of profit); understanding how they view insurance coverage will help both doctors and patients when it comes to dealing with insurance coverage and claims.

For insurance carriers, orthodontics can be a pain in the…neck. There are multiples providers (the orthodontists) providing many different types of services (fixing your teeth!), and billing for them in many different ways. Some orthodontists charge patients a certain percentage of what their insurance covers, others charge up front, and others have deferred or adjustable payment plans. It can get downright messy for the patient, the office manager, and the insurance company employee stuck in their cubicle trying to figure out what to allow, what to deny, and what is going on.

The View of Orthodontic Insurance From the Patients

When it comes to orthodontic insurance, the patient is probably feeling more pain from the bill than from the appointment. Virtually all orthodontic insurance is several limited. Most plans have a maximum lifetime benefit and a maximum yearly benefit. Many of these maximum benefit limitations apply to the entire family. So, if both Little Johnnie and Little Susie need years of braces, a good percentage of that money is coming out of mom and dad’s pockets. If Mom decides she wants to get her pearly whites straightened, she will probably need  a second job because her family’s insurance benefits have probably run out! 

The View of Orthodontic Insurance From the Orthodontic Office

Orthodontic insurance may be the most annoying and frustrating for the orthodontic office. As a patient, this may seem untrue because it seems like the office will be getting paid very well for their services. However, payments can be slow in coming from the insurance carrier. Insurance companies often lose paperwork and request the same information over and over again. Most orthodontic office managers work very hard, doing multiple tasks; they don’t have the time to be preparing and sending the same paperwork two or three times.

Though orthodontic insurance is no picnic for either the insurance company or the orthodontist office, the patient is the one mostly in the dark. Patients should know and understand their benefits before treatment starts. If they don’t understand something, they should keep asking questions until they get clear answers that make sense.

Most offices will not render services based on the assumption that your insurance company will pay. That is why it is vital to get all paperwork in on time and allow the office to research your insurance coverage so they can tell you what is covered before your treatment starts. 

Most everyone will need to pay for orthodontic treatments (whether for yourself or your children) at some point in time. Having a basic understanding of your orthodontic insurance benefits before you seek treatment will help you get the maximum benefit and avoid any nasty and costly surprises. 

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