Orthodontic Insurance
If you have orthodontic insurance we will help you to determine the benefit you have available. The average insurance benefit paid to our practice is $1,350.
Note: Medicaid, HMO, DMO, or medical plans are not accepted at our office.
Here is how to find out your orthodontic benefits at Smile Logic:
1. You share your orthodontic policy details
Send your dental insurance information to us so we can call your insurance carrier and research your orthodontic insurance coverage. You can use the form below or email policy details to info@smilelogicortho.com.
- Insurance carrier name
- Patient Name
- Patient Date of Birth
- Policy Holder Name
- Policy Holder DOB
- Group number
- ID Number
Complete the online insurance form below:
2. We research your orthodontic coverage
We call your insurance carrier to get information about your policy’s estimated coverage. At that time we would know if there is any coverage available at our office.
- Participation (in-network or out-of-network)
- Effective date
- Waiting period in days
- Age limit
- Student age limit
- Lifetime maximum ($)
- Benefit used to date ($)
- Benefit payable at (%)
- Deductible per family ($)
- Deductible per person ($)
- Deductible frequency
- Accepts treatment in progress
- Preauthorization requested or required
- Payment frequency
- Initial payment maximum (20% default)
- Monthly payment maximum
3. We calculate your benefit
Orthodontic benefits are typically paid over time based on a percentage of the treatment fee, up to a certain “lifetime maximum”.
Here are some examples to help see how the calculated benefit may be different than what you might expect when you see the benefit payable percentage and lifetime maximum. These examples assume a treatment fee of $6,000 and a length of 24 months.
Note: these example benefits, like example pricing, are illustrative only and do not represent your treatment fee or your specific policy details.
100% with no lifetime maximum - If the treatment fee is $6,000 and your benefit is payable at 100% with no lifetime maximum, your out-of-pocket would be $0. The insurance payment schedule would be: 20% down ($1,200), and $200 per month for 24 months.
100% with $2,000 lifetime maximum - If the treatment fee is $6,000, and your benefit payable percentage is 100% with a lifetime maximum of $2,000, your out-of-pocket would be $4,000 ( $6,000 - $2,000 ). The calculated benefit is less than the benefit payable percentage of 100% x $6,000 because the lifetime maximum caps the benefit at $2,000. The insurance payment schedule would be: $400 down ( 20% x $2,000 ), and $66.67 per month for 24 months [ ( $2,000 - ( 20% x $2,000 ) ) / 24 ) ].
50% with $2,000 lifetime maximum - If the treatment fee is $6,000, and your benefit payable percentage is 50% with a lifetime maximum of $2,000, your out-of-pocket would be $4,000 ( $6,000 - $2,000 ). The calculated benefit is less than the benefit payable percentage of 50% x $6,000 because the lifetime maximum caps the benefit at $2,000. The insurance payment schedule would be: $400 down ( 20% x $2,000 ), and $66.67 per month for 24 months [ ( $2,000 - ( 20% x $2,000 ) ) / 24 ) ].
15% with $2,000 lifetime maximum - If the treatment fee is $6,000, and your benefit payable percentage is 15% with a lifetime maximum of $2,000, your out-of-pocket would be $5,100 ( $6,000 - $900 ). The calculated benefit is less than the lifetime maximum of $2000 because the benefit payable percentage of 15% caps the benefit at $900 ( 15% x $6,000 ). The insurance payment schedule would be: $400 down ( 20% x $2,000 ), and $66.67 per month for 7 months [ ( $900 - ( 20% x $2,000 ) ) / 24 ) ], and one remainder payment of $33.31.
50% with $2,000 lifetime maximum and short treatment time - If the treatment time if 12 months instead of 24 months, and the treatment fee is $6,000, and your benefit payable percentage is 50% with a lifetime maximum of $2,000, your out-of-pocket would be $4,800 ( $6,000 - $1,200 ). The calculated benefit is less than the benefit payable percentage of 50% x $6,000 and less than the lifetime maximum of $2,000, because the insurance monthly payment schedule caps the benefit at $1,200. The insurance payment schedule would be: $400 down ( 20% x $2,000 ), and $66.67 per month for 12 months of treatment [ ( $2,000 - ( 20% x $2,000 ) ) / 24 ) ].
4. We discuss treatment, benefits, and payment options
The treatment fee, number of months of treatment, benefit payable percentage, and lifetime maximum all play a role in the example benefit calculations above.
Discuss pricing for braces, insurance benefits, and financial arrangements during a braces consultation with Dr. Viechnicki.