Get the Most Out of Your Orthodontic Insurance Benefits
April 18th, 2012
It is becoming more commonly known that children should have an orthodontic evaluation by age 7 to determine whether early orthodontic treatment is needed.
But Dr. Thomas Arkle III and Dr. Christopher T. Harris of Arkle & Harris Orthodontics advise parents to beware of aggressive treatment recommendations too early, because going this route could exhaust your insurance benefits if your child needs additional treatment in the future.
This is an important topic that needs to be brought to light because unfortunately, there are some orthodontists who treat children too early and their teeth come out of alignment when they get older, says Charlotte orthodontist Dr. Arkle.
It is true that the American Association of Orthodontists recommends an orthodontic evaluation by age 7, Dr. Arkle says. But quite frequently, no treatment is needed at this early age. However, when it’s recommended, many parents agree to it because they don’t realize that there is such a thing as getting braces for children too early.
Typically, because the orthodontist is viewed as the expert on the matter, parents don’t consider questioning the treatment plan, Dr. Harris adds.
Besides having the malocclusion relapse, payment for treatment a second time could result in more money out of your own pocket.
Orthodontic insurance is a convoluted beast, Dr. Harris says.
Some dental insurance covers no orthodontic treatment. Others cover up to 50 percent of the treatment cost and they have a maximum- usually it’s $1,500.
But then it’s exhausted for life, he says. So if your child needs treatment again, there’s no coverage.
Dr. Arkle and Dr. Harris have seen the consequences of early treatment in their practice when children have been treated too early by another orthodontist, only to have their teeth get out of alignment years down the road.
It’s a rude awakening for parents to learn they’ll have to pay out of pocket for all of the services the second time around, Dr. Arkle says.
So how can you avoid encountering this problem? Dr. Arkle and Dr. Harris have these three recommendations:
1. Get a second opinion.
If your 7- or 8-year-old is recommended to have braces on his/her teeth, get that recommendation confirmed by another orthodontist.
This is imperative if you as a parent are unsure of the treatment plan.
This is a trust relationship, Dr. Harris says. If the parent doesn’t believe or trust I have their child’s best interest at heart, it’s better to get a second opinion.
2. Learn about your orthodontist.
Research your orthodontist to get a better understanding of him/her and their background, experience and education.
3. Find a board certified provider.
Search for an orthodontic professional who is board certified through the American Board of Orthodontics. Only a small percentage of orthodontists achieve this status, and certification shows they have taken additional steps to have their treatments evaluated by peers to ensure their standards of treatment are of the highest quality.
We want to make sure parents understand that just because the AAO recommendation is for evaluation by age seven, it absolutely does not mean treatment is called for in every case, Dr. Arkle says.
The purpose of this evaluation is to assess bite patterns, jaw growth and poor oral habits that could result in the need for treatment later in life. There are some measures that can be taken early to correct bad habits such as thumb-sucking and mouth breathing. Early intervention can prevent the need for future orthodontic treatment in some cases, or result in the need for less extensive treatment in the future.
We just want parents to arm themselves with knowledge so that when recommendations are made, they can make informed decisions about their child’s treatment and they can get the most out of their insurance coverage, Dr. Harris says.
