I got a job earlier this year, around March. They told me it was a short contract, but they signed a deal with the incoming company and my job would be safe. That was unfortunately not the case and the contract ended on July 31st. I was only covered from May-July so I didn’t qualify for the plan to continue insurance independently.
I got braces in May after my insurance started and they only paid one payment to the orthodontist office. They said the payment they made in May covered June and July but that doesn’t seem right. Is there a way to verify that information?
I’m not sure who to talk to at this point, but will probably call the dental insurance company on Monday?
I am already on a payment plan with the ortho but am wondering what I can do to see what the discrepancy is.
Many insurance companies use this approach to prevent people from buying coverage, using it briefly, and then canceling it after the carrier has paid out $2000. This way, the company avoids paying $2k upfront and only receiving one year’s worth of premiums. Instead, they pay in installments and stop payments if you cancel the policy.
Since you aren’t eligible for COBRA, your dental coverage has ended.
Insurance typically covers orthodontics based on the work done each month. From what you’ve shared, it seems the insurance covered the work done up until your coverage ended.
Since you can’t continue coverage through COBRA, you might contact the insurance company to see if you can buy a new plan. However, I’m not sure if they would cover your current orthodontic work, as dental plans often have specific exclusions and limits.
It might also be split billing, which is common in prosthodontics and oral maxillofacial surgery with employer plans.
For example, the dentist or OMS submits a plan of their intended work, and the insurer splits the cost into 2-3 years of quarterly payments. If the payments haven’t covered a service (e.g., due to a layoff) or if a service happens in the future, the patient will be responsible for the remaining cost.
Some plans, due to ADA lobbying, also lose the contracted rate if you exceed the plan’s maximum, meaning you’ll end up paying full price.