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ORTHODONTIC COVERAGE

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age limit
annually
automatic
deductible
history
lifetime
lifetime deductible
lifetime maximum
monthly
ortho
ortho covered
orthodontic coverage
payment schedule
percentage coverage
quarterly
remaining
remaining amount
semi-annually
treatment in progress
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Some patients need braces, Invisalign, retainers, and other orthodontic services. Orthodontic coverage is separate from the other services in the dental plan. Services under ortho have their own percentage coverage, deductible, age limit, and so on.
 
  • Ortho covered
    • we ask if the patient’s plan has orthodontic coverage
    • some plans do not have orthodontic coverage but if the plan has, we should get the important details
  • Orthodontic lifetime maximum
    • this is similar to maximum benefits but it is only for orthodontic services and will not be replenished or reset for the next calendar year
    • for example, a plan may have a lifetime maximum of $2,000, but when this has been maxed out, it will not go back to $2000 in the next calendar year
  • Remaining amount
    • this is the amount that’s left after orthodontic procedures have been done on the patient
    • we have to update the remaining amount in the orthodontic coverage to properly inform the provider and the patient if the ortho had maxed out
  • Deductible (Lifetime Deductible)
    • like the individual deductible, this is an amount that has to be settled by the patient
    • once this has been paid, there will be no lifetime deductible in the next calendar year
  • Age limit
    •  Orthodontic coverage has a specific age limit which we have to ask from the insurance
  • Percentage coverage
    • Similarly, there is specific coverage for the orthodontic procedures
    • this may vary, but 50% coverage is common for orthodontic services
  • Payment schedule – orthodontic treatments such as braces last for several months – maybe 6-12 months
  • Therefore, payment may be done in different options such as the ones below
    • Automatic
    • Monthly
    • Quarterly
    • Semi-annually
    • Annually
 
  • History of prior ortho treatment – this is when we ask if the patient had orthodontic treatment before
  • Treatment in progress covered – this means that treatment the ongoing treatment from a different provider is still covered under the insurance