Orthodontic fees are personalized according to the treatment required. All fees are broken down into an initial payment and monthly payments are made over the time of treatment. There is no interest charged or GST payable on orthodontic treatment. We accept Visa, Mastercard, AMEX, Interac, auto-debit and post-dated cheques. We will not accept payments directly from an insurance company.
Orthodontic benefits work in several ways:
The most common benefit is payable at a percentage with a lifetime maximum of a certain amount. For example: payable at 50% with a lifetime maximum of $1500 per person. Let us say the total charge for braces is $6000. The initial charge is 20% down when the braces are put on: that would be $1200, and this is covered at 50%. The insurance company will pay $600 when you get the braces on, and you are responsible for the remaining 50%: $600.00. The remaining balance of $4,800 is divided by 24 months (the course of the treatment): $200 per month. The insurance company pays this amount at 50%, which is $100 per month until you have reached your maximum benefit. In this case, it is $1,500. If you take the $1,500 minus the $600 paid at the banding date of the braces and $100 per month thereafter, you will run out of benefits in 9 months. After the 9th month, your responsibility would be the full $200 for the remaining months instead of the $100 per month for the first 9 months. In reality, the braces are $6,000 minus your $1,500 benefit with a remainder of $4,500 that is your responsibility.
Some people have an orthodontic benefit as a percentage. The most common percentage is 50%. This is calculated as above: $6,000 total charge, 20% down ($1200), and $200 per month for 24 months. In this case, the insurance company will pay $600 down and $100 per month for 24 months. The patient is responsible for the same. In this case, 50% is $3,000 payable in installments of $600 down and $100 per month.
Most managed care orthodontic plans have a fixed co-pay. The most common co-pay is $1,200 or $1,000. In these cases, you would have to pay your co-pay and the insurance company will pay the remaining balance of the full charge over the course of treatment (24 months). If braces are $6,000 and your fixed co-pay is $1,000, you would pay $1,000 and the insurance company would pay $5,000 in installments.
Some managed plans cover at a percentage. For example, the insurance company will cover 75% of the total fee. The patient is responsible for the remaining 25%. The 25% is considered your co-pay and the insurance company will pay the remaining 75% over the course of treatment. For example, if the braces are $6,000, 75% is $4,500 that the insurance company will cover in installments. Your 25% portion would be $1,5000.