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An explanation of Orthodontic Insurance and Benefits

There is a lot of confusion about medical insurance, dental insurance, and orthodontic insurance. The purpose of this page is to help explain things in a way that will make sense to our patients. Understanding this information can help reduce the amount out of pocket that you pay for braces or Invisalign. Most people have medical insurance. Some people have dental insurance as well. Of those with dental insurance, some have orthodontic coverage for themselves and their children. If you have dental insurance, we will handle all of the paperwork for you free of charge. We will also do what is called “accept assignment of benefits”, meaning that instead of the insurance company reimbursing you after you pay the full amount, we will speak directly with the insurance company to reduce the hassle for you as well as the out of pocket cost.

Garrett Orthodontics tries to make it as easy as possible and completes these tasks for you. There are a number of ways that orthodontists may choose to be involved with the insurance companies and these ways are extremely important for you to understand.

In the following descriptions we will use a situation where the patient owes $5500 for treatment and the patient’s insurance company offers a $1000 benefit.

No participation: Some orthodontic offices do not “file” insurance or accept assignment of benefits. They bill the patient and it is the patient’s responsibility to file paperwork and receive reimbursement. In this case, if treatment cost $5500 and your insurance benefit was $1000, the office would bill you for $5500 and you would be responsible for filing the paperwork and submitting receipts so the insurance would pay their share.

 

Accepting Assignment: This is when the orthodontist’s office agrees to be paid directly by the insurance company. This is easier on the patient because it frees the patient from having to worry about getting reimbursed. For example, if treatment cost $5500 as above, the office would bill you for $4500 and the office would take on the responsibility of collecting the $1000 from the insurance company. The main benefit to the patient is that their out of pocket cost is reduced by $1000.

PPO Participation: When an orthodontist contracts with an insurance PPO and becomes a “preferred provider” the orthodontist agrees to charge those patients with that particular insurance coverage less than the regular fee. This is important because it can significantly reduce the cost of orthodontic treatment. If the cost for a patient’s treatment would normally be $5500, then choosing a PPO orthodontist may reduce their fee to a lower total of say, $4800. They would still receive their full insurance benefit of $1000, but the family’s total out of pocket cost for treatment would be reduced to $3800, saving the patient $700. To help show the differences in costs, we have prepared the following chart as an example based on a simple orthodontic case. In the PPO example, the lower fee represents the discount offered to patients with that plan. Please understand these numbers are only estimates

Orthodnotic insurance chart of benefits

Orthodontic Insurance FAQ

Does Garrett Orthodontics participate in my insurance plan?
Yes. We accept assignment of benefits for ALL insurance plans with orthoodntic coverage and are PPO participants in many major plans. If you have questions about your specific benefit, we are able to explain your benefits as part of your free consultation. If you provide us you plan information over the phone, we will have all the information ready prior to your consultation so you receive the most accurate information.

Does my health insurance cover orthodontics?
We are happy to help you find out. With hundreds of plans available, the only way we can answer that for you is for you to call us and let us check on your benefits for you. We can do this prior to your free consultation.

Does my insurance cover Invisalign?
In most cases yes, you will receive your full benefit toward treatment with Invisalign. There are not currently PPO-type benefits offered for Invisalign treatment, but if you have $1000 worth of orthodontic insurance, the full amount can be applied toward your invisalign treatment.

For which dental insurance plans does Garrett Orthodontics act as a preferred provider?

Aetna

BlueCross BlueShield State

Cigna

Delta Dental

MetLife

United Concordia

I work for “Company X”.  Is Garrett Orthodontics part of my PPO network?
Though all questions like this need to be answered on an individual basis, we can tell you that Garrett Orthodontics participates in many of the plans offered by the largest employers in Charleston and the surrounding areas.

Some of those employers include:

AT&T, Alcoa, Berkeley County Schools, Bi-Lo, Blackbaud, Boeing, Citadel, College of Charleston, Charleston County Schools, Coastal Center Dept of Disabilities, Cummins Turbo, Dentyen’s Shipyard, Dorchester County Schools, East Cooper Medical, Food Lion, Joint Base Charleston, Kapstone Paper, Kiawah Golf Resort, M.U.S.C., Robert Bosch Co., SAIC, SC Ports Authority, Trident Tech, Verizon, VA Hospital, Wal-Mart. 

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