Braces Insurance Question - Live in NC

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#1 Post by **luckeeesmom** » Thu Jun 18, 2009 5:01 am

Hi Everyone,
I have braces and used my companies Delta Dental Plan which has a 50% orthodontic coverage with a lifetime max of $1500. I have filed all the claims and received the $1500 reimbursement. My workplace is changing to Blue Cross Blue Shield Dental Blue group policy which also covers orthodontics up to 50% with a $1500 lifetime max.

Will I be able to get additional reimbursement for my braces since we are now with a new company? I didn't know if anyone on the forum has gone through an insurance transition while braced. I got my braces through the UNC Dental School so my total price was $3600.

#2 Post by **staceyr2** » Thu Jun 18, 2009 6:23 am

I don't think so. I switched jobs during my ortho treatment and I had Delta before, they paid up to 2000 for me. It went straight through my ortho, no reimbursements directly to me. I now have Met Life, but they don't cover adult orthodontics. So I don't have first hand experience, but, insurance companies, doctors, dentists and even orthodontists keep records. Even if you switch insurance, they know what has already been paid out and won't pay out double, they aim to make money. Maybe if you switch ortho too and start a new treatment, but I doubt it seriously. If the total was only 3600, the first insurance paid 1500, that leaves 300 to make it 50%, so if the new insurance company pays anything at all, I doubt it will be more than 300. Good luck and if it works, make sure you post how you did it so others may benefit as well!

#3 Post by **luckeeesmom** » Thu Jun 18, 2009 6:27 am

Being at the Dental School I had to pay and get reimbursed since they do not file insurance at all. I had to do all of my paperwork and claims myself which was time consuming and a hassle but it was worth it because I have saved significantly over going to the orthodontists in my area.

#4 Post by **TumbleDryLow** » Thu Jun 18, 2009 11:07 am

My guess is that this new dental plan will consider your braces a "pre-existing condition" and not cover them. I suppose it won't hurt to try, but you will probably need to enter (or submit from the ortho) when your treatment is to begin. Once they see that it has already begun, they will probably reject the claim.