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This is a rentable site for orthodontists in the state of Louisiana. We specialize in helping our clients grow their business by driving traffic to their personal websites. If you’re interested in renting out one our pages please fill out a form or feel free to contact us!
Benefits of Orthodontics
At various times of the year many employers offer their annual open season where employees have the option of changing, adding, or even dropping medical and dental coverage. Understanding orthodontic benefits can often times be a little bit trickier to figure out than regular dental and medical benefits. Here are a few tips to help you understand your coverage and a few questions you may want to ask when considering changing or adding dental plans as it relates to Orthodontic Coverage.
1. Just because you have Dental Insurance does not mean you have orthodontic coverage. Be sure to ask if your plan covers both. Also be sure to ask if the coverage is for adults and children or just for children. Sometimes there are higher premiums for both dental and orthodontic Coverage but often times there are not. Each company is different. You want to make sure you are not paying more for the insurance than what you are getting in benefits.
2. Orthodontic coverage typically involves a Lifetime Maximum Benefit (LTM) that pays out at 50% of the total case fee. There are a few plans that pay more or less than 50%. This means they will pay for braces 1 time and once you have used all of the LTM they won’t pay any more. If your LTM benefit is $3000, then braces would have to cost $6000 in order for you to use your full benefit. You would pay the difference between what your insurance covers and the total case fee. You’re out of pocket expenses can vary depending on whether or not you choose an in network provider. If your employer changes plans while you or your child are still in treatment the orthodontic payment history will typically follow you. However, if you take out a new plan with a completely different company often times, the history does not follow you and this can result in additional benefits. Anytime your insurance changes be sure to let your providers know.
3. Orthodontic benefits pay out over the course of treatment not in one lump sum payment. If your benefit is estimated at $3000, the Insurance Company generally pays you or the orthodontist an initial payment when the braces are placed and then monthly, quarterly, or annual instalments for the remaining months of treatment. If the orthodontist estimates that you will be in braces for 2 years then you would want to make sure you keep you dental plan during those 2 years. If you drop your dental/orthodontic insurance before your benefit has finished paying this can result more out of pocket expenses for you.
4. Does your plan have a waiting period for orthodontic coverage? Some dental plans require a waiting period before they will pay for braces. They might cover cleanings and general dentistry immediately, but sometimes will have you wait as long as 2 years before orthodontic coverage is active. Be sure to ask you dental plan if there is a waiting period for braces.
5. Can I have dual coverage for braces? The answer is yes in most cases but there are a few rules insurance companies follow when determining primary vs. secondary and you want to make sure your plan allows for standard coordination of benefits. The birthday ruledetermines whose plan is primary and looks at what month the person is born in. For example if mom’s birthday is 2/14/73 and dad’s birthday is 11/20/1968, mom’s plan, in most cases, would be considered the primary insurance plan because her birthday falls first in the calendar year. Overall age or who is older does not generally determine who is primary. Be sure to ask if your plan allows forstandard coordination of benefits or has a non-duplicating clause. A non-duplicating clause means benefits will not be duplicated. So if both plans have a LTM of $1500 then with a non-duplicating clause your total benefit is $1500. When coordination of benefits is allowed your benefit could be as high as $3000 if the LTM for both plans is $1500.
6. What happens if you get Orthodontic Coverage after you/your child has already started treatment? Sometimes an employer will increase their plan benefits or you might even change employers and find yourself with orthodontic benefits that you did not have when you or your child first started treatment. The question to ask your new plan is if they cover work in progress. If they do cover work in progress, then generally your benefit is pro-rated based on how long you have been in treatment and how long you have left in treatment.