Orthodontic Coverage with Private Health Insurance: What to Know

Your Insurance Questions Answered

• 1Does my dental insurance cover my orthodontic treatment?

  If you have dental insurance, your plan may also offer orthodontic coverage. Orthodontic benefits are often separate from the annual dental benefit and are usually payable once per individual on the policy. Diamond Braces will help you verify your insurance information and will work directly with your insurer to help secure coverage.

• 2Who does dental insurance cover?

  Private insurance plans vary widely, but many plans cover anyone listed in the policy, including adults. Depending on the plan, coverage may extend to multiple individuals, or allow you to use the fixed amount of coverage for each individual on the policy. Diamond Braces teams members will assist you to review and understand your plan's available benefits.

• 3Will insurance cover treatment in full?

  Some plans will cover treatment in full, however most private insurances provide a fixed benefit amount, which covers a portion of treatment, not the full amount. Those are once per lifetime benefits. When you visit Diamond Braces for your initial consultation, we will discuss any available insurance information and what portion of the treatment may be covered.

• 4Will I need an insurance approval to start orthodontic treatment?

  No. For most plans, if you have verified that your dental insurance includes orthodontic coverage, Diamond Braces can begin your treatment and bill your insurance provider immediately.

• 5Can I change my plan during treatment?

  Because private insurance varies so widely with orthodontic coverage, we generally recommend that you try to stay on the same plan for the duration of your treatment. If your plan does change for any reason, please notify us as soon as possible. Diamond Braces team members will assist you with verifying any updated benefit information that may affect your treatment.

• 6What happens if I lose my insurance?

  If you do lose your insurance, and/or your new insurance plan does not include orthodontic coverage, Diamond Braces will help you establish a flexible monthly payment plan that allows you to pay in manageable installments. Diamond Braces offers customizable options to fit your budget including extended, zero down payment and no interest plans. You will only be responsible for the portion of your treatment that was not covered by insurance.

• 7Does my plan cover Invisalign?

  Most insurance plans allow members and their dependents to upgrade to elective treatment options such as Invisalign or other clear aligners. For many insurance plans, coverage is the same or similar to traditional braces. A Diamond Braces team member will review your estimated financial commitment for Invisalign treatment at your consultation.

• 8Does my plan cover clear braces?

  Like clear aligners, clear braces are considered an elective treatment option. Most insurance plans will allow you to select your preferred option - see above.

• 9Do I need a referral from my family dentist? 

  The good news, you do not need a referral to see an orthodontist. No referral is necessary to be evaluated for orthodontic treatment; you can schedule a consultation with Diamond Braces and begin treatment right away. Our administrative staff will assist you with verifying and understanding your insurance benefits. 

• 10Is Diamond Braces in my network?

  We recommend you check with your insurance carrier prior to your first visit. Diamond Braces participates with most insurance plans, and we will always work with you to understand insurance coverage and establish flexible payment terms when applicable.