Payment Options and Insurance Information for Orthodontic Treatment

How much do Braces cost in Mississauga?

How much does Invisalign cost in Sudbury?

Are there payment plan options for orthodontic treatment?

We can help you with these questions below!

Whether you need orthodontist in Mississauga or Sudbury, we make a commitment to providing you with affordable, high-quality treatment that fits your budget! We know that the cost of braces or Invisalign plays a factor in deciding whether to commence treatment. However, we believe that financial considerations should not be an obstacle to obtaining a confident and healthy smile. As a result, we offer the following payment options to meet your needs:

• Low Monthly, No Interest Payment
• Low Down Payment
• Prepayment Courtesy for payment in full prior to treatment by cash or cheque

Please ask us about financing options, credit card payments and bank drafts. We thoroughly explain your options so that we can accommodate your needs.

Payment Options in Orthodontics

Initial Down Payment for Orthodontics

A down payment of approximately 10% is made at the start of treatment for any patient wishing to start treatment with Invisalign, with the balance paid monthly over approximately 24 months of the treatment time. For patients who start treatment with clear braces or metal braces, we ask that you pay the first monthly installment based on your payment plan. We have flexibility in our monthly installments as well, so please don’t hesitate to speak with us so that we can accommodate your financial needs. We accept cash, check, and credit cards for the Initial Payment Plan in both our Mississauga and Sudbury offices.

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 and we will be sure to work with this plan for you.

Insurance Coverage

If your insurance covers orthodontic treatment, you will receive the benefit of reduced personal costs. Many insurance policies have a lifetime orthodontic benefit that is distinct from regular dental insurance. Remember that insurance policies vary, and we will review your insurance to determine the appropriate course of action. Once treatment has started, we will provide you with monthly receipts so you can file your claims. No down-payment, no-interest monthly payment plans are available. We also accept Visa, MasterCard and Interact.

Insurance Facts

At Hometown Orthodontics, we strive to give you outstanding treatment results, while utilizing your insurance coverage and other benefit plans effectively.

There are a great number of orthodontic coverages available depending on what your employer purchases. Many patients incorrectly believe that just because they have dental insurance, their insurance company will also cover orthodontics under the same umbrella. This is not always the case. It is very important that you become knowledgeable about your orthodontic insurance coverage prior to your initial consultation with Dr. Virdee. This will allow you to make a more informed decision about treatment with us. The following is a few key questions to ask your insurance company:

• Do I have orthodontic coverage associated with my dental insurance?
• If I do have orthodontic benefits, what is the lifetime maximum payable?
• What kind of fee schedule is used to pay out the benefit?
• Is there a deductible that applies to orthodontics?
• Is there an age limit pertaining to orthodontic benefits?

Predetermination of Insurance Coverage

Once treatment is recommended by Dr. Virdee, we provide you with a pre-determination form that is submitted to the insurance company. This form provides an overview of Dr. Virdee’s proposed treatment plan and gives the insurance company several pieces of key information including Dr. Virdee’s clinical findings, total treatment fee and approximate length of treatment.

After the insurance company processes the predetermination, they will mail you an Explanation of Benefits (EOB) form which details, in writing, the benefits 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.

Multiple Insurance Coverage

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 ways 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 which we can help you with). 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.