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 is meant to be an aid in receiving dental care. Many patients think that their insurance pays 90%-100% of all dental fees. This is not true! Most plans only pay between 50%-80% of the average total fee. Some pay more, and some pay less. The percentage paid is usually determined by how much you or your employer has paid for coverage or the type of contract your employer has set up with the insurance company.

You may have noticed that sometimes your dental insurer reimburses you or the dentist at a lower rate than the dentist’s actual fee. Frequently, insurance companies state that the reimbursement was reduced because your dentist’s fee has exceeded the usual, customary, or reasonable fee (“UCR”) used by the company.

A statement such as this gives the impression that any fee greater than the amount paid by the insurance company is unreasonable or well above what most dentists in the area charge for a certain service. This can be very misleading and simply is not accurate.

Insurance companies set their own schedules, and each company uses a different set of fees they consider allowable. These allowable fees may vary widely because each company collects fee information from claims it processes. The insurance company then takes this data and arbitrarily chooses a level they call the “allowable” UCR Fee. Frequently, this data can be three to five years old are from various parts of the country. The insurance company sets these “allowable” fees so they can make a net 20%-30% profit.

Unfortunately, insurance companies imply that your dentist is “overcharging” rather than say that they are “underpaying” or that their benefits are low. In general, the less expensive insurance policy will use a lower usual, customary, or reasonable (UCR) figure.

When estimating dental benefits, deductibles and percentages must be considered. To illustrate, assume the fee for service is $150.00. Assuming that the insurance company allows $150.00 as its usual and customary (UCR) fee, we can figure out what benefits will be paid. First, a deductible (paid by you), on average $50, is subtracted, leaving $100.00. The plan then pays 80% for this particular procedure. Out of a $150.00 fee, they will pay an estimated $80.00, leaving a remaining portion of $70.00 (to be paid by the patient). Of course, if the UCR is less than $150.00 or your plan pays only at 50%, then the insurance benefits will also be significantly less.

MOST IMPORTANTLY, please keep us informed of any insurance changes such as policy name, insurance company address, or a change of employment.

Orthodontic Finance & Insurance

It is our mission to provide you with affordable, high-quality treatment that fits your budget! We offer a variety of payment options to meet your needs.

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.

PLEASE UNDERSTAND that we file dental insurance as a courtesy to our patients. There is no direct relationship between your insurance company and our office. We are not responsible for how your insurance company handles its claims or for what benefits they pay on a claim. 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,