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Does my insurance cover the cost of orthodontics?  There are many different agreements between insurance carriers and their subscribers, and each contract provides a different benefit. Not everyone with dental insurance will have orthodontic coverage. Please note that orthodontic insurance is different from regular dental insurance in that each insured individual usually has a lifetime maximum benefit for orthodontic services. This benefit is paid as a percentage of the orthodontic fee (diagnostic records, initial fee, monthly payments, etc.) until the benefit maximum has been reached. In some instances, you may have a deductible to meet first.
How can Dr. Burkey's office assist me with my insurance? For your convenience, our office will gladly assist you in calling your insurance company to get an estimate of the amount of your coverage. Once your insurance carrier verifies your orthodontic benefits, we can determine your anticipated balance and arrange a workable payment plan for you. As a service, we will also submit insurance claim forms on your behalf. However, if actual benefits payable differ from the original estimate, please be aware that final responsibility for any unpaid insurance balance will rest with the patient or parent. Is a Predetermination needed? A "predetermination" is not usually needed for orthodontic benefits, yet if your plan requires one, please inform us. If your plan does require a "predetermination", we will submit the treatment plan to your insurance carrier for their review to determine the benefits and limitations of your policy. This usually takes four to six weeks. Does Dr. Burkey's office accept assignment of insurance benefits, and how does this affect my payment plan? Yes, we accept assignment of insurance benefits, therefore our payment plan with you is usually for the patient portion of the fee, not including the insurance portion. It is arranged with the assumption that insurance benefits will be sent directly to our office. The estimated insurance coverage is an estimate only, and the patient and/or parents are responsible for the total fee in the event of a change or discrepancy in the estimated insurance coverage. In the event you erroneously receive benefits which should have been paid directly to our office, we request that you endorse any insurance checks over to us. We will be happy to credit these to your account. Some Delta Insurance plans will not send our office benefit checks and will only send benefits directly to the insured. In those cases, our payment plan with you is for the total treatment fee, not considering the insurance, as we assume the benefit checks will be sent to your home. For those Delta patients, keep any insurance checks paid to you directly unless other arrangements are made. What if my insurance changes? Please notify our office if your insurance benefit is discontinued or modified because of a change in insurance carriers, employee status or termination of employment. If there is a change in the benefit, the remaining balance of the treatment fee is the responsibility of the parent/patient. Our monthly payment plan arrangements would therefore need to be modified. Flexible Spending Plan and Tax Free Dollars Many employers now offer flexible spending plans (FSP) that allow their employees to have a percentage of their wages withheld and deposited (tax free) into a health care benefit plan. The federal government controls the limitations of these plans. Contact your employer to determine the specifics of your FSP. Through a FSP, you determine the amount of money you wish to have deducted from your wages and deposited into your FSP. We can help you clarify the orthodontic charges for a specific calendar year. Once we receive a payment from you, we will issue a receipt. You may then submit this receipt to your FSP administrator requesting reimbursement up to the limit of your plan. We are also pleased to tailor make your payment plan to maximize your flex spending plan benefits. We can arrange for monthly, quarterly, or annual payments of differing amounts to minimize your paperwork and claim submissions, and to help make sure you don't lose any of your benefits.
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