At Dixon Orthodontics, we are in network providers with most major insurance plans. That means that we accept the maximum allowable charges set by insurance, and apply additional benefits to the balance of the cost of treatment. We are experienced at filing claims on your behalf. We also offer flexible, zero interest, in house financing with no credit checks. Our goal is to find a payment plan that works for your budget. Due to the variety of factors affecting treatment, it is not possible to provide a quote over the phone. However, at your consultation, we will provide transparent pricing details so that you can feel confident moving forward with your life changing treatment.
At the start of a new year, many people realize that it’s time to start thinking about braces. Maybe this is the year that your son or daughter should have their teeth examined in order to see if he or she could benefit from orthodontic treatment. Maybe you are not completely happy with your smile and are curious to know how much it would really cost you to have them straightened.
A major factor in determining the cost of your treatment will be your orthodontic benefit. But how do you determine if you have an orthodontic benefit, how much it is and how much it will affect the price of your treatment?
The first step is to just look up your dental benefit. Orthodontic benefits are a sub-category of dental insurance. They do not work exactly the same way as your dental benefit, though. Instead of giving you an annual out of pocket maximum, orthodontic benefits usually have a lifetime out-of-pocket maximum. That means that, unlike dental benefits, orthodontic benefits do not renew annually. In addition, orthodontic benefits tend to be lower than overall dental benefits. What we usually see is an orthodontic benefit of between $1,000 and $2,000. $1,000 is pretty normal, $1500 is good, and if you have a $2000 orthodontic benefit, I would definitely get a jump on that!
Furthermore, orthodontic benefits almost always cover 50% of the cost of treatment, up to the lifetime maximum.* So lets say your orthodontist quotes you a fee of $5000 for a 24-month case. Your benefit will pay 50% of that but only up to your lifetime maximum. So in that case, even if your benefit is $2000, you won’t actually get half of the cost covered but you will be able to max out your benefit.
On the other hand, let’s say your orthodontist quotes you a fee of $2500, and you have a $1500 benefit. Insurance will pay 50%, or $1250, leaving you with $250 remaining for future treatment.
Still with me?
Good. Let’s talk about maximum allowable charges.
If your orthodontist is an in-network provider with your insurance company, it means they have agreed to write-off their fees down to the maximum allowable charges that insurance dictates. For example, if your orthodontist charges $5000 for a 24-month case, but your insurance maximum allowable fee for that procedure is only $4500, an in-network orthodontic provider will write-off their fee down to $4500, and then apply your benefit. So you can see that it is a major advantage to go to an in-network provider like Dixon Orthodontics.
A couple other things:
Orthodontic benefits pay out on a monthly basis, so if you change policies mid-treatment, you will not reap your full benefit. If you get a new policy, we may be able to collect for the remaining time in treatment from that company. Just try not to lose your benefit while you have braces.
And, most policies come with an age limit. The most common I have seen are age 19 and age 26. Be sure to use your benefit before it expires!
Last thing, I promise:
Extra costs associated with Invisalign and ceramic brackets are not covered by insurance. If you want to go that route, be prepared for additional charges.
If you are confused, don’t worry. When you call to schedule your consultation, we will ask you for your insurance identification number. That way, we will have all the information prepared regarding your orthodontic benefits by the time you come in. We will provide you with a written explanation of fees, including our fee, your insurance maximum allowable charge, and your benefit. We will collect the benefit and the remainder will be the patient balance.
That’s it for now, but if you have any other questions about orthodontic benefits, call us anytime and we’ll help you the best we can.
*As a side note, I have seen policies that pay up to 80% of the cost of treatment. If your policy says 80%, get really excited. That’s awesome.