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Insurance and orthodontics: 6 questions answered

Understanding the cost of orthodontics and how insurance factors into the mix can be tricky. At Vivid Orthodontics we want to be a partner in helping you understand your orthodontic insurance benefits. From submitting your orthodontic claims to keeping you updated on changes we encounter, we do our best to make it a smooth process. We’ve also created a quick guide of some of the most common questions regarding orthodontics and the use of insurance benefits.

1. Does insurance cover braces?

Dental insurance policies often have a benefit available for orthodontic treatment, however, there may be restrictions based on the age of the patient and how long the plan has been active. The manor in which an orthodontic benefit is paid also varies from general dental procedures. When visiting the dentist for a routine cleaning, exam or filling, the insurance company typically pays the office for the services in one payment.

Orthodontic benefits are usually paid over the course of the orthodontic treatment in our office.  Insurance often pays a portion of the benefit at banding (when braces or an appliance goes on).  The rest of the benefit is then paid in monthly, quarterly or yearly payments. If treatment is finished before insurance is done paying the benefit amount estimated, whatever they haven’t paid becomes your responsibility. Insurance will only pay benefits during active treatment.

2. What about health insurance?

Unfortunately, health insurance rarely pays for orthodontic treatment. There are strict criteria that must be met for health insurance to cover orthodontic treatment. If we feel you or your child’s case would qualify, we will help you submit a claim to your health insurance.

3. My insurance changed, now what?

People change jobs, employers change plans, and benefits can increase or decrease from year to year. Any time there is a change in dental benefits, it’s important to notify our office immediately so we can make sure the right plan is billed for any active treatment. We will then do our best to estimate what the new benefits will cover and let you know if your out-of-pocket cost will change. By notifying us of any insurance changes right away, we can help ensure there is not a lapse in payment from insurance. It will also help us make sure you get the most out of your benefits.

4. What insurance plans are accepted?

Our office accepts almost all insurance plans. If you have a specific plan that you want to check coverage on, please reach out to us with your insurance information and we will be happy to verify the coverage available. Even if we are out-of-network for your insurance, it is beneficial to have your coverage checked in our office. Unlike general dental procedures, insurance plans often pay the same amount for orthodontic coverage whether you choose a provider that is in-network or out-of-network.

5. Are payment options available?

No insurance coverage? No problem! Vivid Orthodontics offers flexible payment options for orthodontic treatment. Orthodontics is an investment and we want to make sure finances don’t stand in the way of you or your child getting the care you need. 

If you are looking to save on the braces cost, we offer discounts for treatment that is paid in full on the day treatment is started. Flex Spending or Health Savings Accounts are also great options for helping pay for orthodontic treatment.

6. Who do I contact with questions?

Questions about insurance or payment options? Call us a 920-739-2400 to speak to our financial coordinator and they will help you understand the process.

Get started with orthodontic treatment today!

Ready for an orthodontic consultation? No referral is needed and the visit is complimentary. Call us at 920-739-2400 to get scheduled. We proudly serve the Appleton area, including Neenah, Menasha, Little Chute, Grand Chute and Kaukauna.