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Orthodontic Insurance 101

Orthodontic Insurance 101

Insurance can be complicated and is not always what it seems

2 min read

Your smile is yours forever, and we want to make it as easy as possible for you to receive the best orthodontic care and to make it affordable.

Our practice accepts most major credit cards and insurance plans and if you have insurance that covers any portion of your orthodontic treatment our office staff is always available to help you with insurance claims and paperwork.

We understand insurance can be tricky and we want to help you as much as we can in order to make your entire orthodontic experience a pleasant one.

Insurance Coverage

Orthodontic insurance has continued to become more prevalent in helping to pay for orthodontic treatment. The benefits generally range from $1,000 to upwards of $4,000 with some of the higher benefits associated with union memberships.

The benefits paid from insurance companies are frequently paid out at 50% of the fee. For example, if the fee charged is $500, insurance will pay one-half or $250 up to the benefit maximum.

If the treatment is using full braces over multiple months, then the benefits will be paid out over the estimated number of months with 20% or 25% of the benefit paid out at the initial appliance placement appointment. For example, if the case fee is $5,000 and is estimated to take 20 months and the orthodontic benefit is $2000, then $400 will be paid at the placement of the braces and the remaining insurance benefit will be paid monthly at $80 per month for 20 months.

Please keep in mind that deductibles may apply.

Another insurance situation that can become murky is when multiple insurances are utilized. In many cases, the total benefits between the insurance companies will be reduced, and you, as the beneficiaries, may need to deal directly with the companies after we submit your claims on your behalf.

In-network vs. Out-of-network Benefits

Our office gets calls from new patients that frequently ask if our office is in-network for their insurance company. When they look at the benefits, they feel that it is advantageous to look for in-network offices. However, it is important to look at the bigger picture as frequently there are other variables that may be involved that could make an out-of-network the better choice.

First, compare case fees and look for additional fees associated with retention, records, and any auxiliary devices or appliances. Be sure to compare your out-of-pocket costs with the in-network fees to the out-of-pocket costs offered by other offices such as ours. You may be surprised to find that the out-of-pocket cost will be very similar for both offices.

Our office is not in-network with every insurance company, but when comparing the fees of large multi-assistant orthodontic offices with high staff overhead to ours, the financial bottom line is frequently in our office's favor. And that doesn't include the significant advantages in technology and personal care our office provides.

Cost Based on Difficulty

We frequently receive calls from prospective patients asking for the cost of braces or other services. We are different in that we do not have a standard fee for braces. Each case is individualized by the difficulty factor of treating the case and the expected length of treatment.

This is important for comparing in-network vs. out-of-network. In orthodontic offices that charge a standard rate for braces, that cost is often significantly higher than the rates we charge out-of-network since we do not have a standard insurance rate. This is how we may end up costing less out-of-network than in-network with your insurance plan.

Compared to Others

Over the years, we have found from patients that our out-of-pocket costs are very similar to those going to an in-network orthodontic office. How is that possible? Since we do not use assistants our operating overhead is much lower, which allows us to have significantly lower out-of-network costs.

Secondly, the fee Dr. Skarin sets for your treatment is all-inclusive. This also includes retainer visits and maintenance services for as long as Dr. Skarin continues to practice.

If extra steps are needed or if an Invisalign tray did not work as intended, additional treatment is done without added cost to you. In most other offices, additional steps of treatment almost always are added on top of the treatment costs.

We always urge those concerned with in-network and out-of-network costs to get a quote from other offices before making a decision. We find that when people compare apples-to-apples with every benefit and service we are frequently lower in cost.

How We Submit Insurance Claims

We submit insurance claims to all insurance companies and we accept payment from nearly all insurers except for state entities.

In addition, we also extend payment plans for all first and final phases of treatment.

Payment plays are always interest-free and are based on the good-will and mutual trust between the family and our office. We do not utilize a third-party finance company because it not only costs each family more, but more importantly, we value our patients immensely and we treat all of them like family.

Treating You Like Family

We do not believe third-party financing companies are inviting. Third-party financing companies, that many medical and dental professionals utilize, offer to pay treatment costs as an advance. They pay the front office up-front in full before treatment of the patient is even finished in exchange for a significant percentage of the treatment fee. This added cost is usually passed on directly to all of the patients in the practice, even those that do not choose to finance their costs. We refuse to conduct business that way. We also do not feel comfortable accepting full payment for work we have not completed, which is why we do not offer a reduction in cost for paying up front.

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