Introduction
Braces are a common form of orthodontic treatment used to correct misalignment issues with teeth. It is estimated that 4.5 million Americans wear braces each year, and the cost of braces can be significant. Fortunately, many medical insurance plans will cover at least some of the costs associated with braces. In this article, we will explore how to get braces covered by medical insurance.
Research Medical Insurance Plans to Identify Coverage for Braces
The first step in getting braces covered by medical insurance is to research the different plans available. If you already have a plan, it is important to review your current plan coverage to understand what type of braces are covered and any limits or restrictions associated with the coverage. If you do not currently have a plan, then you should compare different plans to find one that meets your needs. Additionally, it is important to understand the types of braces covered, as some plans may only cover traditional metal braces while others may also cover clear aligners or other options.
Contact Your Insurance Provider to Ask About Braces Coverage
Once you have identified a plan that covers braces, the next step is to contact your insurance provider to ask about the specifics of your coverage. This is especially important if you already have a plan, as the coverage may have changed since you first enrolled. When contacting your insurance provider, you should ask questions such as what type of braces are covered, what providers are approved, and what your out-of-pocket costs may be. It is also important to obtain a list of approved providers to ensure that you are able to receive the treatment you need.
Request a Pre-Determination of Benefits to Estimate Coverage
The next step is to request a pre-determination of benefits from your insurance provider. This process involves submitting documentation such as a dental exam and proposed treatment plan to your insurance provider in order to estimate the amount of coverage you will receive. The pre-determination of benefits will help you understand how much of the cost of braces will be covered, any deductibles or co-pays you may be responsible for, and what your out-of-pocket costs may be.
Appeal Denied Claims and Follow Up With Your Plan Administrator
If your claim for braces is denied, it is important to understand the appeals process and file an appeal if necessary. You should also follow up with your plan administrator to ensure that your appeal is being processed in a timely manner. According to a study published in the Journal of Oral Health & Dental Management, “Many times appeals are successful when the patient is persistent and follows the appeals process.”
Conclusion
Getting braces covered by medical insurance can seem like a daunting task, but it doesn’t have to be. By following these steps – researching different plans, contacting your insurance provider, requesting a pre-determination of benefits, and appealing denied claims – you can ensure that you are getting the coverage you need. Don’t forget to follow up with your plan administrator to ensure that your appeal is being processed properly.
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