Understanding Your Orthodontic Insurance

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If you have dental insurance, we will file the claims for you as a complimentary service. It is very important that the correct information is provided at the time of the patient’s appointment. If this information changes, it is the patient’s responsibility to update McBride Orthodontics at their earliest convenience. While we do our best to verify dental insurance benefits, the insurance company is very clear that the benefit information we are given is an estimate and no guarantee of payment. We will provide you with a verbal estimate of your insurance benefit we obtain from your dental insurance for the planned treatment, however, please understand that these are strictly estimates and are not a guarantee of payment. In our orthodontic financial agreement, the insurance allowance we take assignment for is an “estimate.” If for any reason the total insurance assignment is not paid as expected, it becomes the responsibility of the patient. For anyone that has dental insurance through Delta Dental, we are not able to accept the assignment of benefits because we are not in network with them. Therefore, all payments will be paid directly to the policy holder of the insurance.

Insurance payments are paid to our orthodontic office monthly, quarterly, or annually. It is a rare exception that a one-time payment for the entire lifetime maximum is made initially. Typically, insurance will pay a portion for the initial banding and the remaining benefit will be prorated over the remaining months of treatment. While the filing of the claim is a courtesy that we extend to all of our patients, all charges are your responsibility from the date the services are rendered. If difficulty arises with payment from the insurance company, any unpaid balances after 90 days will be transferred to the account holder.

During orthodontic treatment, if insurance coverage is interrupted for any reason, (ex: a job change, your employer changes insurance companies, your coverage is dropped, or treatment is completed early) insurance payments stop. If an insurance change occurs during treatment, it is the patient’s responsibility to inform the office. A new insurance company will not know you are in orthodontic treatment. We must file a claim with the new insurance company and cannot do so if we are unaware of the change!

As a courtesy to our patients, our office is happy to file an insurance claim on the patient’s behalf; however, if the initial carrier has not paid the insurance balance in full, the remaining balance will be transferred to the patient. The patient will be responsible for paying any remaining balance insurance has not paid. Some insurance companies have clauses that will not allow full benefits to be paid if the treatment started prior to the takeover by the new insurance. The benefit may be prorated, or the claim may be denied for coverage.

I understand and agree that all insurance deductibles and any incurred expenses not covered by the policy holder’s insurance carrier must be paid at the time of services.

I hereby authorize payment directly to McBride Orthodontics for any services rendered to me by Dr. Matthew D. McBride or any of their authorized agents.

I authorize the release of all medical information to the insured’s insurance carrier that is:

Acquired during the course of treatment.
Which may have a bearing on the benefits payable under this or any other plan that provides benefits or services.

I authorize Dr. Matthew D. McBride or any of their agents to assist me in obtaining payment from my insurance companies and have the authorization for use of any insurance on the patient’s behalf.

I authorize a copy of this form to be used in the place of the original and that this copy may be used on all my insurance submissions.

I have read and fully understand all the information provided to me regarding my insurance “estimate” for payment.

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