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Orthodontic Insurance 101

Orthodontic Insurance 101

My child needs braces? I have to check with my insurance? I’d rather have a root canal (pun intended).  Orthodontic insurance can feel overwhelming, and for those who don’t have it, it may become a roadblock to getting braces. You may feel like you will spend as much time researching an orthodontist in Charlottesville/Staunton as you would researching a ten-page paper.


The following list will assist you in your “insurance check-up,”
so keep reading in order to pass the Insurance 101 class:


  1.  A referral from your general dentist is not needed to begin orthodontic treatment.


  1.  Mark Cloth Orthodontics is in-network with most insurance companies, and we PPO with many.


  1.  As an additional benefit to you during your free consultation, we can request benefits to help you understand what you can expect your insurance to cover. If you choose to start treatment in either Charlottesville or Staunton, your insurance can be electronically filed at our office.  We help to ensure that you are receiving the benefits within your plan.


  1.  Most insurance plans have a lifetime max (LTM). This means each person covered has an amount to use towards orthodontic care. The average benefit range is $1,000-$3,000.


  1.  Most orthodontic benefits pay out over the course of the treatment. Insurance companies generally pay an initial payment when the braces are placed, and then pay either monthly, quarterly or annually until it is paid out.


  1.  Some dental plans require a waiting period before they will pay for braces, even if they cover cleanings and general dentistry immediately.


  1.  Sometimes employers will increase their plan benefits. You also might 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 (WIP). If they do, then generally your benefit is pro-rated based on how long you have been in treatment and how much time you have left in treatment.


  1.  No insurance? No worries. Dr. Mark Cloth makes getting a perfect smile easy with a financial plan that allows a low monthly payment with zero down and zero interest. Don’t let insurance issues get in the way of your orthodontic treatment.


  1.  You may even have your own questions. Call us at 964-2464, and we will help you find the answer.

You make the call… We’ll do the rest. Now that’s something to smile about.

Dr. Mark Cloth

Charlottesville and Staunton, VA Orthodontist