Financing & Insurance

Typically insurance benefit payments will be sent directly to our practice. There are a few exceptions, such as Blue Cross Blue Shield of NC.

Sometimes a parent and their spouse may each have an orthodontic benefit plan for their children. Most of the time both can be applied, however, they are almost always NOT additive and one of the policies must be identified as the primary policy. Regardless of which policy has better terms for you, by NC law, the policyholder whose birth month is first is designated as primary. When two plans are involved, the insurance companies that issue the policies do not always work well together and it can at times be frustrating. It is important for people to understand that we do not make the rules or laws and do our best to help our patients.

In all of these scenarios, if the insurance plan is no longer active or is canceled, the patient/family is responsible for any portion of the total treatment fee not paid for by the insurance policy.

When families request that we manage two policies simultaneously, we do charge an additional administrative fee.

Once we receive information regarding your insurance company and your specific policy, we will submit the necessary insurance forms for your treatment. There are literally thousands of different policies, and we will typically manage the filing of a single policy on your behalf without charging additional fees. It is not possible for us to be an expert in all policies and there are times where we will need your assistance.

Here is a typical example of how almost every policy is universally administered by insurers: In our example, the patient’s name will be Olivia and her parents have an orthodontic benefit policy that has been added on to her dental benefits plan. The policy states that Olivia has “a $1,500 lifetime maximum benefit up to 50%.” This is the most common benefit amount we see and the “up to 50%” is part of almost every plan offered in the US.

So, let’s break down what this really means.

Olivia gets no more than $1,500 of orthodontic benefit for her entire life. That is the maximum and it does NOT renew like regular dental benefits on an annual basis.
In order for her parents to apply the entire $1,500 towards her braces, the total cost of treatment has to be at least $3,000.

Example 1)

If treatment cost is $1,500 then $750 of the treatment cost will be paid by the insurance policy, and the family would be responsible for the remaining $750 out of pocket. This would leave $750 of Olivia’s lifetime benefit left for future treatment if necessary.

Example 2)

If treatment cost is $3,000 then $1,500 of the treatment cost will be paid by the insurance policy, and the family would be responsible for the remaining $1,500 out of pocket. This would use all of Olivia’s lifetime benefit and zero would be left for future treatment if necessary.

Example 3)

If treatment cost is $4,500 then $1,500 of the treatment cost will be paid by the insurance policy, and the family would be responsible for the remaining $3,000 out of pocket. This would use all of Olivia’s lifetime benefit and zero would be left for future treatment if necessary.

In all of these scenarios, if the insurance plan is no longer active or is canceled, the patient / family is responsible for any portion of the total treatment fee not paid for by the insurance policy.