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Oct 23, 2019
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is it possible through insurance? or only for cash payments ?
let's presume a licensed dentist in USA is a foreign trained orthodontist, what is his/her options?
any advises are appreciated ...thanks
 
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Some insurance companies require me to submit my ortho certificate. Some don't. I guess you can bill the ones that don't require.

I know 2 GPs (my wife's dental classmate and my wife's GP boss), who hire foreigned trained ortho to do in-house ortho tx for their patients. My wife's GP boss had tried a couple of orthodontists before this foreign trained one but all of them quit after a few months. This foreign trained ortho has stayed at my wife's boss' office for more than 5 years.

In order to get a job at corp office and get paid the big bucks, you need obtain an ortho certificate from a US program.
 
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PerioDont

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Some insurance companies require me to submit my ortho certificate. Some don't. I guess you can bill the ones that don't require.

I know 2 GPs (my wife's dental classmate and my wife's GP boss), who hire foreigned trained ortho to do in-house ortho tx for their patients. My wife's GP boss had tried a couple of orthodontists before this foreign trained one but all of them quit after a few months. This foreign trained ortho has stayed at my wife's boss' office for more than 5 years.

In order to get a job at corp office and get paid the big bucks, you need obtain an ortho certificate from a US program.
I'm sure this is area dependent but do you find many insurance companies cover ortho? I have not seen many that do in my area.

the OP like anyone else can charge FFS for ortho just like anyone else can.
 
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Oct 23, 2019
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Some insurance companies require me to submit my ortho certificate. Some don't. I guess you can bill the ones that don't require.

I know 2 GPs (my wife's dental classmate and my wife's GP boss), who hire foreigned trained ortho to do in-house ortho tx for their patients. My wife's GP boss had tried a couple of orthodontists before this foreign trained one but all of them quit after a few months. This foreign trained ortho has stayed at my wife's boss' office for more than 5 years.

In order to get a job at corp office and get paid the big bucks, you need obtain an ortho certificate from a US program.
In California, I know that most insurance companies don't cover ortho tx given by general dentists, what about this foreign trained dentist working for 5 years, is he charging cash payments only? do they have a certified orthodontist at the office visiting every 2-3 months? how much can we charge for a simple two arches tx.?
 
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I'm sure this is area dependent but do you find many insurance companies cover ortho? I have not seen many that do in my area.

the OP like anyone else can charge FFS for ortho just like anyone else can.
Can you explain this "the OP like anyone else can charge FFS for ortho just like anyone else can"

and do you have any idea about situation in California?
 
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I'm sure this is area dependent but do you find many insurance companies cover ortho? I have not seen many that do in my area.

the OP like anyone else can charge FFS for ortho just like anyone else can.
A lot of dental insurances cover ortho. Some plans pay orthodontists $1000. Some pay $1500. The patients have pay the remaining balance out of their pockets. When I joined the corp offices, they gave me a big stack of insurance paperwork for me to sign. At my own offices, half of my patients use their dental insurances and the other half pay cash.
 
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In California, I know that most insurance companies don't cover ortho tx given by general dentists, what about this foreign trained dentist working for 5 years, is he charging cash payments only? do they have a certified orthodontist at the office visiting every 2-3 months? how much can we charge for a simple two arches tx.?
I don't know. I don't usually ask my GP friends how they run their ortho businesses. It's a sensitive subject since I am an orthodontist and I need their referrals. My wife's GP boss used to refer a lot of ortho patients to my office. Eversince he hired this ortho, he kept most of the ortho cases in house. He still refer a few patients to my office.....patients who have insruance plans that his office doesn't accept....and cases that his in-house ortho doesn't want to treat.

This is a free-market country. You can charge your patients whatever you want.
 
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A lot of dental insurances cover ortho. Some plans pay orthodontists $1000. Some pay $1500. The patients have pay the remaining balance out of their pockets. When I joined the corp offices, they gave me a big stack of insurance paperwork for me to sign. At my own offices, half of my patients use their dental insurances and the other half pay cash.
Just to add .....

Insurance companies are in business to make money. One way is to play the waiting game on providing the ins. benefit. With ortho ..... most insurance companies will not provide the entire $1000 or $1500 or whatever in one chunk payment. They realize that ortho is treatment carried out for a period of time (12-24 months). They will pay annually, semi-annually, quarterly, and some monthly. If at any time .... the patient loses that benefit (laid off, changes job, changes health/dental plan, etc. etc.) .... any remaining benefit is lost forever. Oh. Patients just love to hear when they lose some or most of the ortho ins. benefit only to have that amount tacked on to their patient responsibility portion.

Yep. The insurance game. Say your office manager forgets to file the insurance claim on a new ortho start. 6 months goes by. Some sleazy insurance companies will not allow you to file the ins paperwork on treatment that was already started.

How about when the insurance company states that they will pay 50% of the total tx fee not to exceed .....say $2000. In other words .... to get the FULL insurance benefit .... your ortho fee needs to be at least $4000. Anything less means the insurance benefit will be less than $2000. Knowing this .... how many ortho practices have "adjusted" the total fee so that the patient (practice) can collect the entire amount?

And these are the good insurance types: indemnity. Then you have the PPO/HMO stuff which further dictates your fees.
 
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Just to add .....

Insurance companies are in business to make money. One way is to play the waiting game on providing the ins. benefit. With ortho ..... most insurance companies will not provide the entire $1000 or $1500 or whatever in one chunk payment. They realize that ortho is treatment carried out for a period of time (12-24 months). They will pay annually, semi-annually, quarterly, and some monthly. If at any time .... the patient loses that benefit (laid off, changes job, changes health/dental plan, etc. etc.) .... any remaining benefit is lost forever. Oh. Patients just love to hear when they lose some or most of the ortho ins. benefit only to have that amount tacked on to their patient responsibility portion.

Yep. The insurance game. Say your office manager forgets to file the insurance claim on a new ortho start. 6 months goes by. Some sleazy insurance companies will not allow you to file the ins paperwork on treatment that was already started.

How about when the insurance company states that they will pay 50% of the total tx fee not to exceed .....say $2000. In other words .... to get the FULL insurance benefit .... your ortho fee needs to be at least $4000. Anything less means the insurance benefit will be less than $2000. Knowing this .... how many ortho practices have "adjusted" the total fee so that the patient (practice) can collect the entire amount?

And these are the good insurance types: indemnity. Then you have the PPO/HMO stuff which further dictates your fees.
That's why we have non-patient days (10 days a month) that my office manager can use to call the insurance companies to make sure we get paid. My manager can also use the morning to call since we only see patients from 2pm-6pm. Some of them put her on hold for more than an hour. Life would be perfect if we didn't have to deal with these insurance companies and if everybody paid cash.
 
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