Question: We have new insurance coverage, what should I do?

If the new coverage is with the same employer, check with the human resources department to see whether you need a new pre-authorization. If you or your spouse has brand new coverage, you will need to call us to receive a new pre-authorization. You would then receive a confirmation from the new company as to the coverage that is still available if the patient is mid-treatment.

Changing employers and/or insurance companies during the course of your orthodontic treatment:

If you are working for the same employer and that employer changes insurance companies during your orthodontic treatment, you can submit a claim to the new insurance company. That claim will be prorated according to the date the braces were put on and how many months of treatment are required. The new insurance company will consider how many months the prior insurance company has paid and how many months are left of treatment. In this case, usually, the new insurance company picks up the payments where the other company has left off. The word "usually" is used because when you have the same employer, your benefits should continue even though your employer has changed insurance companies. But, in some cases, there might be a pre-existing clause in your new benefit and the new insurance company will not continue payments. If this is the case, you should try to appeal to get your full benefit from your employer.

If you change employers, your benefit from the first employer will be stopped automatically. You can submit a claim to your new insurance company from your new employer and location. The new insurance should pick up payments when your orthodontist sends in a claim and submits the amount of months left of treatment. Sometimes this is not covered due to a pre-existing clause in your new benefit.

In a nutshell: Insurance is complicated for orthodontic treatment due to the length of treatment and different plans. It is important to know your benefit, lifetime maximum, how it is paid and at what percentage.