How Orthodontic Insurance Works

Investing in your smile is one of the most rewarding things you can do for yourself and your oral health, there’s no doubt about it! However, having questions about how you can make treatment an affordable reality for you and your family is totally normal. Dr. Delplanche’s flexible payment plans can help you cover your portion of the total cost – but what about your orthodontic insurance plan? Learning how orthodontic insurance works to lower your cost of treatment can make the financial aspect of your straight smile journey much more understandable, and the Delplanche Orthodontics team is happy to help explain. 

How Orthodontic Insurance Works

At first glance, orthodontic insurance might seem a lot like regular health insurance. After all, they’re both designed to help you cover the cost of care, right? However, orthodontic benefit plans function differently than most health insurance plans. They may cover some procedures fully and others only partially, and they often come with stipulations that patients should be aware of. 

Because the subtle differences between the two types of coverage can impact the way you pay for treatment, it’s important to understand how orthodontic insurance works both in general and for your individual policy. 

Here’s how orthodontic benefits work in most cases. 

Single Procedure Billing

From the point of view of your orthodontic insurance provider, braces and Invisalign treatment are considered as one long procedure performed over time as opposed to a series of separate appointments. Because of this, your insurance benefit is often paid out over the course of treatment in monthly installments rather than co-pays at every visit, like your medical insurance. 

Monthly Installments 

Just like you might pay your portion of the treatment cost in monthly installments, your insurance plan does, too! It’s very rare for orthodontic insurance policies to pay for your treatment in one lump sum, and this can affect your coverage if you lose or change insurance policies (see “Filing Work-In-Progress Claims” in the section below). 

Lifetime Maximum

Most orthodontic insurance companies have a lifetime maximum coverage policy, which means that they will cover a percentage of the treatment cost up to a limited amount (for example, your policy may pay a percentage of the total cost up to a lifetime maximum, such as $2,000 toward orthodontic treatment in your lifetime as a whole). This is important to note as it could affect your coverage if you have already had braces or Invisalign in your lifetime and are visiting Delplanche Orthodontics for retreatment later in life. 

Secondary Insurance

It is not uncommon for patients to have more than one insurance policy covering orthodontic treatment. In fact, orthodontic benefits are usually an add-on to your overall dental plan. 

Coordination of benefits refers to the way multiple insurance policies work together to cover treatment. Policies with standard coordination are typically additive, meaning you should receive benefits from both! Policies with a non-duplication clause, will not pay what the primary insurance has already paid. It is important to be aware of any non-duplication clauses, waiting periods, or other details about how your plan pays.

Know Your Coverage Plan

Dental benefits can vary greatly, so it’s extremely important for you to understand the limits of your orthodontic insurance coverage. We recommend that you review the specifics of your plan before starting treatment to make yourself aware of what your policy covers and what it does not. 

How Orthodontic Insurance Works

How Delplanche Orthodontics Helps You Maximize Your Coverage

Understanding the network of orthodontic insurance paperwork and terminology can be difficult, but our team is dedicated to helping you maximize your benefits to reduce your total cost. 

Filing Insurance Claims

At Delplanche Orthodontics, we have a dedicated team member who manages all insurance-related work for our patients, including filing initial claims, preauthorizations, appeals, and the like so that you don’t have to. This takes much of the weight off your shoulders so that you can focus on the most important thing: your or your child’s smile. 

Filing Work-In-Progress Claims

Sometimes, patients and their families change orthodontic insurance companies in the middle of treatment before their insurance provider has paid the total number of monthly installations owed. While we advise against changing policies until your benefits have been paid out when possible, these changes are often out of your control. If this happens, our team can help you file for work-in-progress benefits through your new policy. 

Assignment of Benefits

In some cases, insurance companies default to reimbursing you as the subscriber rather than making direct payments to Delplanche Orthodontics. However, by assigning the benefits directly to us, we can cut out the middleman and reduce your total out-of-pocket cost and reduce your wait time for reimbursement. By separating out the estimated insurance benefits, we’re able to make your payment plan much more affordable!  

Monthly Updates

To help us both stay on the same page, our team will send you a monthly statement highlighting your dental benefit payments and your financial account status. 

Orthodontic Insurance FAQs 

What insurance policies does Delplanche Orthodontics accept? 

We accept most major insurance providers, including Delta Dental of Oregon/Moda, Delta Dental of California, Delta Dental of Washington, Metlife, Cigna, Aetna, United Healthcare and Regence BlueCross BlueShield of Oregon. If you don’t see your insurance on this list, just give us a call and we will be happy to check to see if your plan can be utilized at our office. 

I switched insurance policies. Now what? 

When possible, contact us before you change so we can give you our most common insurance policy details to look for in a new plan, but if your plan has changed, the first thing you should do is contact our office to let us know about the update. We will verify your new insurance plan and discuss your account status, as well as your new monthly payments, with you if there is any change to this status. We can also help you file a work-in-progress claim to your new insurance and offer advice if you expect a lapse between coverage periods. 

How Orthodontic Insurance Works

Making Your Treatment Easier, One Claim at a Time

Although becoming familiar with your orthodontic insurance policy can be a complicated process, you’re not alone. The Delplanche Orthodontics team is dedicated to helping you and your family maximize your benefits and minimize your stress so you feel comfortable with the treatment process and look forward to your results. If you have any questions about payment options or if you want to get started with treatment, call our office in Beaverton or Lake Oswego