FINANCE & INSURANCE

Team Member Front Desk Helpful Finances Insurance Scheduling WakE Orthodontics and Pediatric Dentistry

Finance made easy. We are proud to work with and file with all insurance companies!

It is your responsibility to understand your benefits and coverage and assume responsibility for what your insurance does not cover. We offer finance options to cover what insurance doesn’t cover.

Dental insurance serves as assistance for obtaining dental care. Many patients mistakenly believe that their insurance covers 90%-100% of all dental expenses, but this is inaccurate. Typically, most plans only cover between 50%-80% of the average total fee, with variations depending on factors like coverage payments made by the individual or employer, or the contractual agreement with the insurance provider.

You might have observed instances where your dental insurer reimburses you or your dentist at a rate lower than the actual fee charged by the dentist. Often, insurance companies cite the exceeding of the usual, customary, or reasonable fee (“UCR”) as the reason for reduced reimbursement. Such statements can wrongly suggest that fees above the insurance payment are unreasonable or significantly higher than the local standard, which is misleading and untrue.

Insurance companies establish their fee schedules, with each company employing its own set of allowable fees. These fees can differ widely, as each company collects data from processed claims and selects an “allowable” UCR Fee arbitrarily to ensure a net profit margin of 20%-30%. Unfortunately, insurers may imply that dentists are overcharging rather than admitting to underpayment or low benefit coverage. Typically, cheaper insurance policies tend to use lower UCR figures.

When estimating dental benefits, it’s crucial to consider deductibles and coverage percentages. For example, if a service fee amounts to $150.00 and the insurance allows $150.00 as the UCR fee, the benefits can be calculated as follows: deducting the average deductible (usually $50), leaving $100, then applying the plan’s coverage percentage (e.g., 80%), resulting in an estimated payment of $80, with the remaining portion of $70 to be covered by the patient. However, if the UCR is less than $150 or the plan’s coverage is only at 50%, the benefits will correspondingly decrease.

Above all, it’s important to keep us informed of any changes in insurance details such as policy name, insurer address or employment status.

Orthodontic Finance & Insurance

At Wake Orthodontics and Pediatric Dentistry, our goal is to help you receive your best-fit treatment that is not only top quality, but also affordable and budget-friendly. Read about our different payment options below.

Our flexible finance options include: 

  • We accept Visa, Mastercard, American Express, and Discover.
  • We also offer payment arrangements by which monthly payments can be drafted directly from your checking account, savings account, or credit card.
  • For customers who pay in full at the beginning of treatment, we offer discounts.
  • We also offer a 5% discount for families with multiple members in treatment.
  • We thoroughly explain your options so that we accommodate your needs.

Insurance

Most dental insurance policies cover 80% to 100% of dental work needed during a given year; however, orthodontic insurance is different. Most orthodontic policies cover 50% of the cost, up to a specified lifetime maximum set by each insurance company. Before your first appointment, we ask that you become familiar with your benefits so we can provide the most accurate information regarding your out-of-pocket expenses throughout your treatment.

In-Network Coverage

We participate in-network in the following insurances:

Orthodontics: Delta Dental of North Carolina

Dental Insurance Policy

As a courtesy to you, our patient, we will file your primary dental insurance claim for you if we have received all of your insurance information on the day of the appointment. We will also accept assignment of benefits. We will file your insurance claim for you, and you will be expected to pay your estimated uncovered portion at the time of service. You must be familiar with your insurance benefits, as we will collect from you on the day of treatment the estimated amount insurance is not expected to pay. Once the insurance company reimburses our office, if there is still a balance, you will be billed for the remaining portion. If there is a credit, you will be sent a refund check. Please be aware our office does not file secondary insurance.

We file all insurance electronically, so your insurance company will receive each claim within days of the treatment. You are responsible for the entire account balance. If your insurance company does not pay on your claim for some reason, you will be expected to pay it in full within 30 days of the date of treatment. Please note that some insurance carriers will not reimburse our office directly. In such instances, you will be responsible for the full cost of each visit at the time services are provided, and your insurance company will send you the reimbursement check directly.

As a courtesy to our patients, we will file your dental insurance. There is no direct relationship between your insurance company and our office. We can only assist you in estimating your portion of the cost, and we will verify your benefits before treatment whenever possible. If you have any questions, we will be happy to assist you. Please do not hesitate to call.

In-Network Coverage

We participate in-network in the following insurances:

Pediatric Dentistry: BCBS of NC and Grid+ Network, Cigna Standard and most Delta Dental Plans.

INVISALIGN® COSTS

You are your best investment. No matter what you’ve believed in the past, a confident, radiant smile can be yours. It is within reach. And if you think about it, improving your smile is an important investment because you’re doing it for yourself.

Many factors determine the costs of your Invisalign® treatment: how extensive the issues you want to be corrected, how long your treatment plan will last, and the specific treatment details prescribed.

We strive to make Invisalign® affordable to everyone. You can get a beautiful, healthy and straight smile for as low as your monthly cell phone bill.

Invisalign® Payment Options

  • 5% discount for payment in full

  • Low and no down payment options are available

  • Finance free extended monthly payments to fit your budget

  • Various payment arrangements to coincide with your Flex Plan needs

  • Most major credit cards accepted

Insurance

If your dental plan covers orthodontic treatment, you may also qualify for Invisalign®. Talk to your insurance provider to determine the extent of coverage for your treatment.

Learn more about our financing. To schedule a free consultation to determine if Invisalign is right for you,