change dental insurance in the middle of ortho treatment

[fac]

This is slightly different from my other thread on whether I should pay upfront for my kid's ortho treatment...

I was quoted a price based on us being covered by MetLife dental, we have signed the contract. However, I was told by DH that the company is going to change dental insurance company, I know the orthodontist only has contract with MetLife. Here are my questions and hope someone can answer.

a. The fact that we change insurnace, will it affect the price of the ortho treatment?
b. The insurance is supposed to cover $2000 for the ortho treatment, I assumed the dental office has not submitted the charges, when can the office begin submitting the charges? will the cost be prorated into 1/4 of the total cost, given it will take approximately 4 years (2 years with braces and 2 with retainer)?

 

[allison443]

These things vary so much among different orthodontist offices and different insurance companies. When is your plan going to change? Your best bet is to contact both insurance companies and find out which one will cover your child's expenses. Also, the orthodontist's office may not accept all plans.

I know it is confusing, but we also had Metlife dental, however our plan could be totally different than yours, so your best bet is to find out your particular coverages.

Good luck.

 

[fac]

My plan will change on January 1. For the existing ortho, they only accept MetLife. I am not sure whether the fact that I already signed the contract will make a different. I assume it must have happened to someone...

 

[ancestry]

My experience is that orthodontists can only bill the insurance for the services they have provided -- meaning they can't bill a lump sum upfront. They have to either bill the insurance monthly or after each appointment.

It will affect your contract -- no doubts about it. If you no longer have the type of insurance that the orthodontist accepts then you will have to pay out of pocket for everything. I'm sure somewhere on that contract it says that if your insurance doesn't pay you are responsible for the difference. For example say the contract is based on the insurance paying an average of $80 per months and you paying $40. Once you switch insurance (which your orthodontist no longer accepts) you will have to pay the $120 out of pocket directly to the orthodontist.

If I were you I would address this upfront directly with the orthodontist prior to starting the treatment. Let them know of the possibility and find out what they will do when the change happens.