There are many different types of dental insurance plans, PPOs, DMOs, and discount dental plans, each having different rules and restrictions on coverage for braces or Invisalign Clear Aligner and sorting out these differences can be a daunting task. We, at Orthodontic Specialists, will explain your particular plan and benefits as clearly as possible, and work with your insurance on your behalf.
Orthodontic Specialists is participating with DMO Aetna Insurance Plan. With any DMO Insurance plan, pre-authorization is required. The benefits vary widely with each covered employer such as:
- Some plans have no lifetime maximum
- Some have only a co-pay
- Some only cover comprehensive treatment
- Some only cover a Phase I treatment plan
Our Insurance coordinator is here to assist with any questions you may have about your benefits.
The most common type of dental insurance are PPOs also known as Preferred Provider Organization – most people have these. These plans are usually offered through your employer and are accepted by almost all dental offices. PPO plans usually allow a fixed amount for you to apply toward the cost of your orthodontic treatment. If you have a PPO plan, here are a few things you should find out:
- Does my plan have orthodontic benefits?
- If so, what is the lifetime maximum coverage amount?
- Are there any age limitations?
- Who does the orthodontic benefit apply to? Myself only or my dependents as well?
- Are there any waiting periods?
- In the case of dual coverage; “Is there a coordination of benefits clause on my plan?”
In general, orthodontic benefits have a lifetime maximum coverage. Typically full treatment plans range from 18-36 months, with the payout prorated over the expected months of treatment. For Phase I patients, where treatment times range from 6-12 months, you should expect to receive a portion of the lifetime benefit. The remainder of your benefit can be utilized when full treatment starts.
When you call to schedule your initial complimentary examination, our front desk staff at Orthodontic Specialists. can assist in verifying your orthodontic benefits for you.
The most common insurance carriers that offer PPO dental plans are Aetna, Cigna, Delta, Guardian, MetLife, and United Concordia. Orthodontic Specialists participates in all these major PPO networks.
CHIP is a state and federally funded health insurance program available in Pennsylvania to all uninsured children who meet eligibility guidelines.
To qualify:
- The child must be a Pennsylvania resident.
- The child cannot be enrolled in any other health care coverage, nor be eligible for Medical Assistance or Medicare.
- The child must be under 19 years of age.
- The child must be a U.S. citizen, a permanent legal alien or a refugee as determined by the U.S. Immigration and Naturalization Service.
- The orthodontic treatment for the child must be deemed “medically necessary”.
Orthodontic Specialists does participate with United Concordia Chip and will submit all diagnostic records and paperwork for approval. If approved, only metal braces are allowed – you cannot opt for clear braces or Invisalign.
Contrary to what most people think, discount dental plans or sometimes called “dental insurance alternatives,” are not dental insurance. At Orthodontic Specialists we do participate with Dentamax. Usually offered on websites such as dentalplans.com, for a low monthly or annual fee, these plans allow its members to see certain dental providers for a discount off their usual customary fees.
The above information is just a general overview of most dental plan’s orthodontic benefits. If you seek more specific detail about your particular plan, it is best to contact your HR department or your insurance carrier directly.
If you do not have or are unable to qualify for coverage, please note that our treatment fees are highly competitive and we do offer interest free payment plan options. We’ll work with all patients at Orthodontic Specialists to find a payment option that works best for you and your family.
