Getting braces in Phoenix, Tempe or the surrounding areas is affordable and convenient at OoLi Orthodontics. Orthodontic treatment represents a significant investment in your or your child’s dental health and overall well-being. To make financial obligations as comfortable and affordable as possible, we offer many flexible payment options.
Braces with OoLi are affordable and worry-free:
- 100% Price Match Guarantee
- No down payment financing
- 0% interest financing
- Flexible monthly payment plans
- Discounts for payment in full
- All major credit cards accepted
At OoLi Orthodontics there are no hidden fees. Everything that you need for your confident smile is included in your financial package. Only the procedures performed by your dentist and other specialist are not included. The details of the procedures performed at OoLi Orthodontics and procedures, which maybe required, from your dentist and other specialist will be presented to you at your consult.
Our insurance coordinator will help you determine your benefits and will process the forms you submit. We will do all we can to ensure you receive maximum coverage.
Cafeteria plans, flexible spending accounts, or accounts that take advantage of using pre-tax money to pay for medical treatment – in recent years, these plans have become very popular. If you have one, we will work with you to help make payment arrangements so that you can take advantage of your program. We ask that you know your plan’s terms and limitations, because some of these plans are very specific.
At various times of the year many employers offer their annual open season where employees have the option of changing, adding, or even dropping medical and dental coverage. Understanding orthodontic benefits can often times be a little bit trickier to figure out than regular dental and medical benefits. For your convenience, OoLi Orthodontics participates with many insurance plans and we will happily file the insurance on your behalf. Here are a few tips to help you understand your coverage and a few questions you may want to ask when considering changing or adding dental plans as it relates to Orthodontic Coverage.
Just because you have Dental Insurance does not mean you have orthodontic coverage. Be sure to ask if your plan covers both.
Also be sure to ask if the coverage is for adults and children or just for children. Sometimes there are higher premiums for both dental and orthodontic Coverage but often times there are not. Each company is different. You want to make sure you are not paying more for the insurance than what you are getting in benefits.
Orthodontic coverage typically involves a Lifetime Maximum Benefit (LTM) that pays out at 50% of the total case fee. There are a few plans that pay more or less than 50%. This means they will pay for braces 1 time and once you have used all of the LTM they won’t pay any more. If your LTM benefit is $3000, then braces would have to cost $6000 in order for you to use your full benefit. You would pay the difference between what your insurance covers and the total case fee.
Your out of pocket expenses can vary depending on whether or not you choose an in network provider. If your employer changes plans while you or your child are still in treatment the orthodontic payment history will typically follow you. However, if you take out a new plan with a completely different company often times, the history does not follow you and this can result in additional benefits. Anytime your insurance changes be sure to let your providers know.
Orthodontic benefits pay out over the course of treatment not in one lump sum payment. If your benefit is estimated at $3000, the Insurance Company generally pays you or the orthodontist an initial payment when the braces are placed and then monthly, quarterly, or annual installments for the remaining months of treatment.
If the orthodontist estimates that you will be in braces for 2 years then you would want to make sure you keep you dental plan during those 2 years. If you drop your dental/orthodontic insurance before your benefit has finished paying this can result more out of pocket expenses for you.
Some dental plans require a waiting period before they will pay for braces. They might cover cleanings and general dentistry immediately, but sometimes will have you wait as long as 2 years before orthodontic coverage is active. Be sure to ask you dental plan if there is a waiting period for braces.
The answer is yes in most cases but there are a few rules insurance companies follow when determining primary vs. secondary and you want to make sure your plan allows for standard coordination of benefits. The birthday rule determines whose plan is primary and looks at what month the person is born in. For example if mom’s birthday is 2/14/73 and dad’s birthday is 11/20/1968, mom’s plan, in most cases, would be considered the primary insurance plan because her birthday falls first in the calendar year.
Overall age or who is older does not generally determine who is primary. Be sure to ask if your plan allows for standard coordination of benefits or has a non-duplicating clause. A non-duplicating clause means benefits will not be duplicated. So if both plans have a LTM of $1500 then with a non-duplicating clause your total benefit is $1500. When coordination of benefits is allowed your benefit could be as high as $3000 if the LTM for both plans is $1500.
Sometimes an employer will increase their plan benefits or you might even change employers and find yourself with orthodontic benefits that you did not have when you or your child first started treatment. The question to ask your new plan is if they cover work in progress. If they do cover work in progress, then generally your benefit is pro-rated based on how long you have been in treatment and how long you have left in treatment.
There may be an age limit to receive benefits from your insurance company. For example, with some insurance coverage, the age limit for orthodontic benefit is 19 years old.
Flexible Spending Accounts (FSAs) are a benefit offered by many employers, and are funded with employees’ pre-tax dollars. FSAs help Americans pay for a variety of out-of-pocket health care costs such as co-pays, deductibles, prescription drugs, vision care, hearing aids, and dental services – including orthodontic treatment. FSAs are limited to $2,600 per year as of 2017.
The fee that is presented to you at the consultation includes everything that you will need for your braces. All treatment rendered at OoLi Orthodontics is considered in this fee. However, be aware that any services rendered by a dentist outside of our office will incur additional fees.
We hope you find this information useful and as always if you have further questions about your specific plan please don’t hesitate to call our office and ask to speak with our Insurance Coordinator. This information and any benefit quotes are only an estimation and not a guarantee of services or payments.