Financial and Insurance

What are my payment options?

Orthodontic treatment is an excellent investment in an individual's health and wellbeing. Because of this, we believe financial considerations should not be an obstacle to obtaining this procedure. Being sensitive to the fact that different patients have different needs, we provide the following payment options:

Low Monthly Payment / No Initial Payment

Prepayment Courtesy

A prepayment courtesy of 5% is given for payment in full prior to treatment by cash or check or credit card.

Initial Payment Plan

A down payment of approximately 25% is made at the start of treatment, with the balance paid monthly over approximately 24 months of the treatment time. We accept cash, check, and credit cards for the Initial Payment Plan.

Company Flex Plan

Your company may offer a medical spending account, which allows you to set aside pre-tax dollars to pay for your medical expenses. Please contact your employer for more details.

Insurance Coverage

Our practice will be happy to assist you in determining whether your insurance company will cover your orthodontic treatment. If your company does provide a benefit, our team will be happy to assist in filing your claim."

Please feel free to contact our practice to discuss any of the options listed above and to continue reading below for more information.

Insurance Facts

As we work with you to create your wonderful new smile, we understand that part of this process includes financial considerations. At Furino & Hamlin, we strive to give you outstanding treatment results, while utilizing your insurance coverage and other benefit plans effectively.

There are literally hundreds and hundreds of types of orthodontic coverage depending on what your employer purchases. Policies for orthodontic treatment can at times make determining your benefits difficult. Below are a few key questions to ask your insurance company when determining what your coverage will be. Please keep in mind that, if you are c to see us for an initial visit, we will be checking on your insurance benefit for you.

  1. Do I have orthodontic coverage associated with my dental insurance?
  2. If I do have orthodontic benefits, what is the lifetime maximum payable?
  3. What kind of fee schedule is used to pay out the benefit?
  4. Is there a deductible that applies to orthodontics?
  5. Is there an age limit pertaining to orthodontic benefits?
  6. Can the benefit be assigned to (paid directly to) the dentist?

Predetermination

Once treatment is recommended by our doctors, we can then submit a pre-determination to the insurance company. This is basically an overview of our proposed treatment plan, and it provides the insurance company with several pieces of key information including the doctors clinical findings, total treatment fee and approximate length of treatment.

After the insurance company processes the predetermination, they often respond on paper with an Explanation of Benefits (EOB) form. This actually states in writing the benefit the insurance company expects to pay for your treatment. As with the actual insurance benefits themselves, EOB’s can come in a variety of formats and some are easier to read than others. At this time, if you have questions about what is or isn’t covered, you can either call your insurance company directly, or you are always welcome to contact us for additional information.

Usual And Customary Rate (UCR)

The most confusing element insurance companies use is what they call UCR. UCR is referred to by insurance companies as Usual and Customary Rate. Many times your coverage is based on a percentage of UCR. UCR is NOT a reflection of the usual fees for dentists in your area, but rather is a maximum fee that the insurance company is contracted to pay. The confusing part arises when an insurance policy says it will cover 100% of a particular treatment, only to find out that in fact that is not so, because it actually refers to 100% of UCR, which is not usually the dentist's fee. Typically UCR is anywhere from 10% to 40% lower than actual fees for an area.

Types of Insurance Plans

All insurance plan descriptions stated here are generalized and do not represent specific plan types. It is also possible that exceptions to these descriptions or newer classifications exist. Please check your individual plans carefully.

  • Regular Indemnity Insurance Plans
    These are traditional insurance plans (includes some self-insured plans) that place NO restrictions on your choice of general dentists or specialists. You never have a list of providers from which to select. Indemnity plans are usually the most flexible dental plans available.
  • Preferred Provider Organizations (PPO / PDO / PDP)
    These insurance plans are more restrictive because they provide you with a list of preferred providers (general dentists and specialists) from which to choose. Depending on the plan and insurance company, you may have a wide or narrow choice of providers. You have the flexibility of selecting another dentist or specialist from the list, at any time, for any reason. Providers on the list agree to a contracted (i.e. reduced) fee. Some PPO also allow you to go off their list and select other dentists while maintaining benefits. However, your out of pocket expenses may be slightly higher at an "off the list" dentist, where you can be responsible for the difference between your plan benefit and the dentist fee.
  • Dental/Health Maintenance Organizations (Dental HMOs, DMOs) or Capitation Plans
    You are required to select one primary care provider from a list, and can only obtain treatment from that office. These plans are even more restrictive and inflexible. Dentists receive a low monthly dollar amount for each client that selects their office, they also agree to a very much reduced fee for their services and receive very reduced or NO insurance reimbursement for many procedures. Clients are still responsible for co-payments on treatment provided. You usually have to obtain a referral from your general dentist to see a specialist. You may change your primary care provider, but it involves contacting the HMO administrators who will switch you to the new provider.

More Than One Insurance Policy

For clients with coverage from more than one insurance policy, there are general rules designated by your respective insurance companies for how to manage payment with the different policies.

Primary and Secondary

In general, if there is a primary insurance and a secondary insurance, the policy that is primary is the one to which you are the subscriber. A secondary policy is one where you are covered under someone else's policy. These are not choices you can make, but rather determined by your insurance company.

Consideration & Types of Secondary Claims

There are many different ways an insurance carrier considers secondary claims. Coordination of Benefits (COB) is the typical way insurance carriers deal with more than one insurance carrier. Basically the two insurance carriers would coordinate the benefits between each other in order to pay 100% of the fee charged but not to exceed the charge amount, so the client or the doctor would not profit from being over compensated for the expenses.

The other types of calculating secondary insurance are Maintenance of Benefits (MOB), Carve Out, Limited Coordination, Non-Dual and Integration of Benefits. All of these types usually do not pay anything secondary. The contract language is written so that if the primary carrier paid the same or more than what the secondary carrier would have paid if they had been primary, then they (the secondary carrier) is not responsible for any payment at all. (It would be a duplication of benefits).

Integration of Benefits, the toughest form of non-duplication, means the sum of the total benefits paid by either carrier may satisfy the maximum of the secondary carrier. For example, if the secondary carrier has a plan year maximum of $1500.00, and the client had a $3000.00 bridge or oral surgery paid at 50% by the primary plan, the secondary carrier says it has satisfied its maximum for the entire plan year even though it was the primary carrier that paid the $1500.00! The secondary carrier hasn't paid anything, but it has satisfied its maximum.

It is so important when verifying benefits to find out exactly how the insurance company handles secondary claims.

Remember when submitting "pre-treatment estimates," all carriers estimate their benefit payment as if they are primary.

Dependents

The designation of which policy pays first for dependents again depends on the rules of your insurance company. The typical rules for dependents of parents not separated or divorced with overlapping coverage rely on birthday of the parent, gender of the parent, or some other rule. For divorced/separated parents, specific custody rules usually apply, unless some specific arrangement is agreed to by each party. These designations are unique to each particular insurance.

When Does Secondary Pay

Usually, the secondary policy will not usually accept a claim until after the primary claim is paid, and then the secondary policy will often require a copy of that payment information (referred to as an EOB, explanation of benefits).

Will you get the percentage reimbursement stated during the initial phone verification? maybe.

Any reimbursement would be subject to the conditions and restrictions of your particular plan. If you have any questions about what treatment is covered, please be sure to contact your insurance company [you will likely require specific information such as treatment codes]. The percentage of reimbursement from your insurance company is determined by their fee schedule, which is not related to local dentists' fees. The percentage of insurance reimbursement DOES NOT mean you will receive that percentage of fee you are charged, just that percentage of what the insurance has agreed to pay in their contract with you and/or your employer.

** Based on a loan with an 8.9% APR for 60 months. Terms of the loan may vary based on the treatment fee and credit information. All figures are estimates.