Another braces question - Insurance?

[TheLittleRoo]

We changed insurance plans almost 2 years ago to get better coverage for braces. We will be out of the 2 year "waiting period" in about another 4 months, in October. But it only pays for $1500 lifetime expenses per child.

After reading on the other thread that braces seems to cost about $4000, I wonder if anyone knows whether you can start braces out of pocket, and then submit a portion to insurance to capture their portion of $1500 along the way? I would hate to have it ruled "ineligible" but I would also like to get started.

Lastly, what if you move halfway through the 2-3 year treatment? I know we'll be moving out of state sometime during DS's treatment. This would have to be somewhat common among orthodontists. Does anyone have any experience with this either? Was there a big fee by the new ortho to take your child?

 

[TaraPA]

Our ortho said it had to be billed to insurance up front, when we paid for the braces (we chose to pay them in full up front, minus insurance, for the cash discount - AND for all those Disney VISA points!!!). I'm sure if it's a small practice or you know them well they may be able to work with you on this.

Our insurance also has a $1500 lifetime max per child. I don't think it matters if you move or where you use the coverage - we live near a state line & often use doctors & dentists in one state, and then the other, and there's never been a question. They've often picked up treating something in one state that a doc in another state started with no fees.

$4000 for full braces over 2 years sounds like a great deal! Around here the minimum is $6000....shoot me now....

 

[patsal]

The $1500 lifetime is most likely at 50%. For ours, we had to have a plan set up where the payments were $100 per month for several years with a huge downpayment before they would start work. After each payment was submitted they would submit to the insurance co and I'd get 50% back until the benefit was exhausted. Unfortunately it doesn't take long to exhaust it. I had two with braces and both had two phases after all was said and done it was about $10,000 each with the insurance reimbursing $3000 for each. Each of my children started treatment in K and finished by grade 7.

 

[ceecee]

They will bill the insurance in monthly installments the day the bands/brackets are placed (some insurance will pay all up front, ours did) and they pay $1500 total, so if there is a phase II it's not covered at all. They will most likely put you on a 24 month payment plan. If you move, you will need to find another orthodontist in your area which would take him on as a patient to finish tx. They will give you a reduced fee (maybe ask for a referral, as orthodontists vary with their txs). Some do the phase I and II routinely and others wait until the permanent teeth are mostly in. Sometimes a phase I is necessary.

 

[Kriii]

We unexpectedly moved out of state during dd's braces treatment and our experience was this: since we had pre-paid the first phase of treatment, we ended up losing money b/c we still had to pay the new orthodontist 700.00 to finish the first phase treatment and our small refund from the original orthodontist did not cover this cost. When it was time for the second and final phase of treatment we opted to make monthly payments rather than the less expensive pre-paid plan simply b/c we expect to transfer again and didn't know whether that would be before or after the second phase was completed and didn't want the same thing to happen again. Orthodonists, in my experience, do require a sizeable downpayment in addition to the montly payments (in our case about 1,200.00) so I would carefully consider when to start the treatments. If you expect to move a few months after braces are put on, you may want to wait until you move to start the process.

 

[penguin087]

I thought about waiting to use the insurance money too but our orthodonsist made a good point to us. If you wait a year how do you know you will still have that insurance? If you have new insurance and they have already started treatment in most cases it will not cover. They will consider it preexisting.
We used the insurance coverage up front. The office billed them the entire amout (almost $6000 ), the insurance company paid the $1500 our plan covered, then the ortho billed us for the remainder. We set up interest free payments through the office. I know not every ortho does this.

 

[TheLittleRoo]

Maybe I'm from the Stone Age, but what is this Phase I / Phase 2 stuff? We waited until DS13 had all his permanent teeth to evaluate whether he'd need them. He does. <rats!>

When I was 13, I had my canines pulled and braces took about 2.5 years. When my wisdom teeth came in, they were also pulled post-braces. I had a retainer for about a year after braces came off. Is this no longer normal? Did I save money waiting, or cost myself more?

 

[patsal]

Phase I is early intervention and Phase II is the actual straightening and placement of the teeth after all permanent teeth except the wisdom come in. My kids started phase I in grade K and Phase II in about 5th grade. By 7th grade all finished with retainers. Both of my children had to have the quad appliance to crack the roof of the mouth and reshape it and DD had a bad cross bite that was pretty much fixed by phase I, Phase II straightened the teeth and moved them so they were "perfect". The biggest benefit is less permanant damage to the jaw and facial structure with early intervention and less time in braces. They also do not like to pull teeth anymore but rather to make room for them so the crowding is alleviated by other means.

 

[Tink561]

My oldest son had comprehensive treatment and not the separate phases. It worked for him. Phase 1 was successful for my second son and a total flop for the third one. My younger sons were late bloomers as far as their permanent teeth were concerned.

Now at 15 (well, next month) my youngest son will be going into braces again. He will have to have the palate expander as well as a full set of braces and reverse pull headgear. I'm quite irritated because it seems like at least some of this should have been done during phase 1 like it was for my second son.

We don't have orthodontic coverage so we paid for all three rounds of orthodontic coverage and used one of the fancy places so now I found out they were higher. I honestly didn't question their treatment of my third son sine we had used them for years but now I really have to question if they did anything.

I have purchased one of the discount dental plans and found an orthodontist that gives a 20% discount with that plan. So now we're going to pay about $4000 for this newest round of treatment. He will finish just before his senior year.

 

[msmayor]

Maybe I'm from the Stone Age, but what is this Phase I / Phase 2 stuff? We waited until DS13 had all his permanent teeth to evaluate whether he'd need them. He does. <rats!>

When I was 13, I had my canines pulled and braces took about 2.5 years. When my wisdom teeth came in, they were also pulled post-braces. I had a retainer for about a year after braces came off. Is this no longer normal? Did I save money waiting, or cost myself more?

To just build on what another poster already said, the early-intervention allows them to create room in the mouth where none existed WITHOUT pulling healthy teeth, something dentists no longer wish to do.

The palate is still pliable and growing up until the age of 12, when it reaches its maximum size and hardens. Using the expander allows them to 'stretch' out the palate and force it to make space for the incoming adult teeth, but this must be done before the palate hardens. After 12, it doesn't matter what you do, that palate isn't going to change.

 

[Tink561]

The palate is still pliable and growing up until the age of 12, when it reaches its maximum size and hardens. Using the expander allows them to 'stretch' out the palate and force it to make space for the incoming adult teeth, but this must be done before the palate hardens. After 12, it doesn't matter what you do, that palate isn't going to change.

I didn't know that. I need to discuss that at my son's appointment this week. He is almost 15. They told me they were going to expand his palate. I'm getting more confused.

 

[msmayor]

I didn't know that. I need to discuss that at my son's appointment this week. He is almost 15. They told me they were going to expand his palate. I'm getting more confused.

Well, I'm no professional but that's how it was explained to me.

I'd definitely ask more questions about this.

My son is 14, and during his last dentist visit they suggested an Ortho consult ($250). When I pressed the dentist for details about the problems with his bite, he said he didn't really have any. So I asked "Why braces then?". He alluded to the 'social' aspect, and the fact that some kids are self-conscious about their smile. So I said "You mean, you're suggesting them for COSMETIC reasons?" He said yes, there is a bit of straightening that could be done on the bottom that he might want.

Uh.....no....I don't think so. If they're not MEDICALLY necessary I'm not shelling out $5k.

 

[Tink561]

Well, I'm no professional but that's how it was explained to me.

I'd definitely ask more questions about this.

I will, thanks. I just searched and read a couple of things. Evidently sometimes they can work and the fusing of the palate may be linked to oral development. Since my son was late losing baby teeth his palate my not have fused yet and this could work. He lost his last baby teeth just over a year ago.

I will definitely ask before they do anything.

 

[Tink561]

My son is 14, and during his last dentist visit they suggested an Ortho consult ($250). When I pressed the dentist for details about the problems with his bite, he said he didn't really have any. So I asked "Why braces then?". He alluded to the 'social' aspect, and the fact that some kids are self-conscious about their smile. So I said "You mean, you're suggesting them for COSMETIC reasons?" He said yes, there is a bit of straightening that could be done on the bottom that he might want.

Uh.....no....I don't think so. If they're not MEDICALLY necessary I'm not shelling out $5k.

I agree completely! My middle son's phase one corrected all of his real problems but his bottom teeth aren't perfectly straight. I'm not shelling out more $$$ just to make them model perfect.

 

[littlelulu33]

I do orthodontic billing this is what will happen. If you choose to start treatment now and have no ins. then get ins. when the coverage is started we can start billing. A couple of things can happen you need to check with your ins co if they pay for "IN PROGRESS TREATMENT" some co do and some don't. DON'T TAKE HR's WORD FOR IT! Also some ins co have a cap for what the orthodontist can collect monthly even if we bill for $200 a month to try and get the 50% making it $100 per month paid to the office they may have a cap of $50 per month and you will not get the entire $1500.

So I would call the ins co and ask if there is a max they pay monthly and if they pay for in progress treatment. Also other good questions to ask if it is a fee schedule and are there different max/fee if we see a in network orthodontist. We have families that get very upset if they pick ins up during treatment and the office is unable to collect the entire ortho max. People tend to blame the office as if we did something wrong because HR tells them that they will pay.

Some ins co will pay the entire $1500 up front and others will pay a down payment and then monthly payments for the remaining months. This does not matter how you pay you portion. Also if you change jobs mid treatment and have new ins with ortho coverage and they pay in progress you can get that as well. If a employer changes coverage mid-way with treatment most of the time they carrier over what you have already used, but some times patient luck out and they will have a entirely new max and we can collect that as well. Keep the ins. biller in the office aware of any changes as soon as possible this will help things along.

Also if you move there are form that the treating orthodontist has to fill out and send to the new office. The office that you are currently in treatment with figures out a % that you have paid and ins has paid and what has been completed on the patient to see if there is a refund due. The new orthodontist will give you fees for his office and you will pay them for finishing treatment. In my experience you usually wind up paying more out of pocket for the treatment but it really depends on what the current orthodontist gives for a refund. If you are paying monthly you may not get any type of refund and hopefully the new orthodontist will have the same fee plan for you to follow.

If you have any more questions you can PM, I am also working in the office this week I would be happy to call your ins and get your info. for you. Ins gets very confusing. I have been doing this for about 8-9 years and ins co are always changing how they are doing things.

 

[siestakeys04]

The only thing I have to say on the subject is DD braces will be paid for this AUGUST!!!!!!

I am taking that 150 a month and put into a vacation club for our trip next year!!!!!!!!!!

 

[Tink561]

The only thing I have to say on the subject is DD braces will be paid for this AUGUST!!!!!!

I am taking that 150 a month and put into a vacation club for our trip next year!!!!!!!!!!

YAY!!!! We are starting our fourth round of ortho payments.

 

[HugsForEeyore]

All of you who have any sort of insurance for braces are so fortunate! I did over 3 years of braces as an adult, plus a horrible surgery before I could even begin! I had not one drop of insurance, so everything last thing was out of pocket, for a total in the $9000 range.

When I was a kid, my parents refused me braces, even though I desperately needed them. So I was almost stuck in a Catch-22 when I had crooked teeth as a young adult - I knew my poor appearance was preventing me from presenting myself well and landing a good job, yet I needed a career and a good job to pay for braces so I can look better! I eventually depleted my entire savings (babysitting money) to pay for the braces, but it was the best thing I ever did. Straight teeth are absolute neccessary today. Parents who give their kid braces are doing a wonderful thing, giving them every advantage to their future success.

 

[torinsmom]

My son got his braces on when he was 12. Our dentist said no ortho consult until he had all his permanent teeth in. He had lots of space in between his teeth and some were turned outward. We found an orthodontist who did not require a downpayment. The cost was $3400, which included almost 2 years of actual braces, and 18 months of retainers. Insurance paid $2000 of that.

My ex's company changed dental insurance plans during my son's treatment. Since he didn't have a lapse, the new insurance continued to pay

DS13 gets his braces off in September! I have about $250 left to pay! Yippee!

Marsha

 

[TheLittleRoo]

The whole phase thing sounds like a racket to me, sorry! I'm reading posts where parents are saying their child's teeth fit b/c the palate is expanded, yet the teeth are still crooked requiring another set of braces for cosmetic reasons.

Call me "swamp mom" but I have no objection to pulling out healthy (UGLY!) canines to allow the rest of the teeth to move simply and easily into place. I hope the orthodontist doesn't look down on me for suggesting it! My son's canines would give Count Dracula a fright!

His teeth are straight for the most part, just need some tilting here and there. In fact, he doesn't even want braces but I know he needs them to have a professional smile. He just doesn't want the metal, which isn't enough reason at 13 to forgo a killer smile at 25 trying to launch his career.

I'll see what my ins co says, but talking to them is like speaking Swahili -and you still need something in writing in case there's a "misunderstanding".