Cost and Insurance FAQ’s for Orthodontic Treatment Plans

Answers to Common Questions Regarding Insurance and Fees

At Haas Orthodontic Arts, we understand the financial commitment you are making when you invest in a smile. To help you through the process, we’ve compiled some commonly asked questions regarding fees and orthodontic insurance. Because individual plans vary and orthodontic insurance is very different from other insurance, contact your insurance company or employer for specific questions regarding coverage. If you have additional questions, please contact our business administrator.

How do I pay for care?
There is no charge for your child’s initial exam. However, there is a $75 exam fee for adults. Should orthodontic treatment be recommended and diagnostic records taken for study, a nominal fee will be charged. The records fee is $325, which includes full mouth x-ray, models, a cephalometric film, analysis and diagnosis. It is due on the day of service.Once we’ve made our diagnosis and discussed the treatment plan, and you’re ready to proceed, our office manager will review the various payment options with you.
What is the average fee for orthodontic treatment?
Orthodontic fees can vary widely depending on the individual case. Having an orthodontic exam is the best way to get an accurate estimate. Some very simple cases may be treated with a retainer for less than $850. Most patients require braces, which involves considerably more time and expense. In 2014, the cost of braces for our patients ranged from $4,500 to $6,000, with the average around $5,200.
Do I have to file the insurance claims?
No. As a courtesy to our patients, we file all claims and complete any follow-up.
How will my insurance company pay?
Most insurance companies make a down payment, then make either quarterly or monthly payments over the course of treatment. Very few insurance companies pay the full amount at the start of treatment.
When will my insurance company get billed?
The day a fixed appliance is placed on the teeth is considered the start date. If you will be getting new orthodontic insurance, it may be worthwhile to hold off on treatment. Our doctors can help you make that decision.
What happens if I change companies or lose my job?
Orthodontic benefits end if you change companies or lose your job. Any balance the insurance company did not pay will become your responsibility. We will work with you to get your balance paid in full. If your new employer offers orthodontic insurance, we will file for benefits as soon as you are eligible.
What is a work in progress clause?
A “work in progress” clause states that if treatment has already begun, the patient is not eligible for benefits. This is something to watch for if you change jobs. Check with your employer or your benefits handbook.
What happens if I get new insurance during treatment?
If you get new insurance during treatment, let us know so we can verify coverage and file claims for you. In most cases, you will not receive the down payment, but will receive the regular payments from the effective date through retention.
What if we have coverage from 2 insurance plans? Can we use both?
In most cases, you can. Insurance companies use the “birthday rule,” meaning they use the birthday that comes first in the calendar year and that person’s coverage becomes the primary insurance. Typically, you receive the benefits from that insurance, while the secondary insurance pays at a certain percentage (usually 50 percent), up to the lifetime maximum. If there’s a “non-duplication clause,” the secondary insurance will not pay for duplicate benefits.
What is a lifetime maximum?
The lifetime maximum is an amount set by the insurance company as the maximum amount the plan will pay. It can range anywhere from $750 to $2,500. It is per family member, usually through age 19 and up to age 23 if the patient is a full-time student. (Most adults are not covered through orthodontic insurance.) You can verify the lifetime maximum through your employer or benefits handbook.
I have dental insurance. Can I assume I have orthodontic coverage too?
No. While it may seem strange, dental and orthodontic insurance are separate.
Can I use my insurance as my down payment or to pay my account?
No. Each responsible party has a separate account. Insurance proration is different and separate from the patient proration.
Do you accept Medicaid HMOs?
We are currently a provider for the Buckeye Community Health Plan and Unison Health Plan. Haas Orthodontic Arts Akron on Weathervane Lane is the only state-affiliated office, which is where Medicaid HMO cases are seen. To receive treatment, the Medicaid member must be at least 10 years old. The maximum age for orthodontic treatment through Medicaid is 21. Some plans have specific referral requirements that must be followed to receive an orthodontic evaluation. For these requirements and all other Medicaid-related questions, contact our Cuyahoga Falls office at 330.869.0137.