Orthodontist • Mt. Vernon & Orcas Island, WA
Insurance Information
Understanding Your Orthodontic Insurance
We work closely with your insurance company to submit claims and help maximize your benefits, but it’s important to understand that each plan has its own coverage and limitations. If your treatment involves two phases, we will apply your benefits accordingly, and payments are typically spread out over the course of treatment.
Should your coverage change or be lost during treatment, any remaining balance may become your responsibility. We’re here to assist you through the process and ensure your treatment proceeds smoothly, so please keep us informed about any changes to your insurance.
Benefits: We submit claims as a courtesy to our patients and we do all that we can to have the insurance company pay the claim. However, each dental plan has limitations and different coverage. It is the responsibility of the patient to understand their plan benefits related to orthodontic services.
Two Phase Treatment: In the case that our office recommends two phases of orthodontic treatment, our office may only receive a portion of your insurance benefit for Phase 1. Any unused benefit may be applied towards Phase 2 as long as the policy is still active.
Payments: It is important to note that orthodontic benefits are rarely ever paid out upfront. Depending on your insurance company, payments will be spread out over the course of treatment in monthly, quarterly, or yearly installments/payments. Therefore, coverage MUST remain active throughout the entire course of treatment to receive the full benefit.
Loss/Change in coverage: Please be aware-if coverage is lost/changed during treatment, any unpaid balance by your insurance company will be transferred to your balance and become your responsibility.
Work in Progress: Please inform our office immediately of any new coverage so we can submit a claim in a timely manner. It is not unusual for your new insurance to prorate your benefit based on what the prior coverage paid and/or the remaining treatment time. Note: Not all plans allow for work in progress, the unpaid insurance balance will be transferred to your balance and become your responsibility.
Dual Coverage: Double coverage occurs when a patient is enrolled in two active dental policies. Our office will do our best to determine how much each policy should pay. Note: Some exclusions may be present on your policy, making it impossible to collect both.
Additional Procedures: If extractions/exposures are needed for orthodontic treatment, it is important to note that your policy may combine these procedures with your orthodontic maximum benefit. Therefore, our office will not receive the full anticipated benefit and the remaining unpaid balance will become your responsibility.
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