Eligibility
Requirements for eligibility vary by policy. Some policies require a waiting period for new employees, while others may require a specific number of hours to be worked per pay period to remain eligible. more
In some cases, orthodontic coverage is only available to dependent children under the age of 19.
If you are unsure of your eligibility, you should refer to your plan booklet or contact your employer's insurance administrator. In addition, we would be happy to contact your insurance company to pre-authorize or inquire about your coverage. Pre-authorization does not obligate you to treatment in any way.
How Benefits Are Calculated
There is no universal formula for calculating the amount to be paid
toward the initial appliance placement fee or subsequent monthly fees.
Each policy maintains its own formula. more
As an example, however, it is common for orthodontic benefits to be paid at 50% of the treatment fee to a lifetime maximum amount. Your policy may have a yearly deductible. Most policies allow us to bill an initial payment of 25% of the total fee with the remaining payments made monthly over the course of treatment.
Flexible Spending Accounts (FSAs) / Health Savings Accounts (HSAs)
FSAs and HSAs have become a very popular method of projecting pre-tax dollars to be spent during the next plan year. The plans commonly allow insureds to allocate a specified number of salary dollars toward certain expenses, usually medical, dental, or childcare expenses. more
Because these dollars are not subject to payroll taxes, they are a very attractive way of increasing the value of your "insurance dollars."
In most cases, there are very specific rules about when orthodontic treatment is initiated to receive the greatest benefit. For instance, you must declare the amount to be spent for the year prior to the beginning of the plan year. The plan year for the policy may not be a calendar year.
Health Savings Accounts (HSAs) are another type of tax-advantaged plan. Although dollars and expenses do not need to be projected for the plan year as with FSAs, HSAs do allow you to pay orthodontic expenses on a pretax basis.
Whatever the account, you stand to receive the greatest benefit by planning how orthodontic treatment can fit into the rules of your account. We're happy to help ensure you receive the greatest benefits available to you. To do so, please schedule an office meeting well in advance of the date you must declare your FSA allocation or as you review your HSA contributions.
Multiple Insurance Coverage
If you are covered by more than one orthodontic insurance policy, the carriers will determine which plan is considered the primary policy. more
Often this determination is made by birth dates of the insured parties. The method of determination is not universal, but varies with each carrier.
The secondary insurance carrier will not declare or pay benefits until the primary carrier has made a determination of treatment that will be covered. The secondary carrier usually requires written confirmation from the primary carrier of the benefits to be covered. Recently, some secondary carriers are reducing their coverage by the amount paid by the primary carrier.
Payment
Before your treatment begins, fees are discussed. The cost of your treatment will vary depending on your orthodontic needs. more
Our fees reflect your individualized treatment plan and can only be estimated after your initial, complimentary evaluation.
Following your evaluation, our insurance coordinator can submit an estimate to your insurance company to establish a pre-treatment determination of your benefits.
OSGB also offers patients interest-free payment plans depending on their credit histories. A credit bureau report can be obtained to determine whether you qualify for the interest-free benefit.
OSGB provides the additional conveniences of online payments and automatic transfer of funds.
Ongoing Assistance
After providing us your insurance information, we will bill your insurance
carrier directly. more
We employ a specialist in the language and coding of insurance claims and will work as your advocate to help you attain the maximum benefits from your insurance plan.
Please feel free to contact us with any questions or concerns regarding your insurance at 920.336.6805.
Understanding Your Insurance Coverage and Responsibility
As you begin orthodontic treatment, it's important to understand your insurance coverage. Orthodontic benefits are typically separate from dental benefits. Even though you are covered by dental insurance, you may not have orthodontic coverage.
Your employer provides a plan booklet that describes the details of your policy and should outline any orthodontic coverage that might be available to you and your family. We recommend that you familiarize yourself with the details of your coverage to avoid any misunderstandings.
At your initial visit, we'll contact your insurance carrier for you to verbally confirm your orthodontic
insurance benefit.
