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What Parents Need to Know about Affording Braces for a Child with Autism in Connecticut
During the past three weeks, in between snow, snow days, and winter illnesses, I have been genuinely straight-out busy.
Many people think that if they don't hear from me for a while, I'm possibly missing in action. But truth be known, I'm a researcher at heart. And the more people my research can help, the digger I deep.
I like to uncover the most hidden information that the public may otherwise never know.
If you are the parent of a child in Connecticut, and your child is on state insurance, I have some amazing news to share with you. There is financial help available to children who need braces.
Specifically, I am writing this for parents of children with Autism, but it applies to everyone who may be in need.
Having had a really straight set of teeth most of my life, I never had to worry about orthodontics or braces.
But now having a child with Autism that also has excessive teeth crowding, I've been on a journey that has brought me to writing this article. It all started last spring 2013.
I went for a routine dental examine with my son where we go to his regular dentist every six months. My son's eye teeth seemed to be growing in behind teeth that were already there. I thought the dentist would just pull out the extra teeth. Because I've never been through this, I wasn't expecting involvement of specialists.
Within a few moments after looking at the teeth in concern, the dentist informed me that I would have to call an orthodontist. They referred me to a local orthodontist in the area. The dentist also has a child with Autism and assured me the orthodontist would be great with my son.
Anyone with a child with Autism knows the struggles and challenges in taking the child anywhere. Time countdowns to help transition the child from one activity to another. Informing the child's school that they will be out a portion of the day because they need specialist care. Packing a bottle of water and a healthy snack for the car ride. Making sure that there is a goody bag for your child so he or she doesn't become bored and suddenly start kicking up the back seat. Yes, these are the issues parents face daily, never mind the extra time and caution it takes to drive your child to an appointment.
We were ready. Teddy bear in hand. Coloring books and crayons for the waiting room. Snack pack for the car ride. Wet wipes for his hands. Mom's medical reports all categorized by date and in order by doctor. Off we went.
The office building was conveniently located right off the highway with a short two left turns. We rode the elevator and appeared on time for the appointment.
Of course we weren't expecting the giant fish tanks in the first part of the office suite, or the free snacks available to patients. My son grabbing for everything in site, touching and fingerprinting the fish tank to his heart's content. I finally convinced him that the toys in the basket to the right corner were much more fun to play with.
An assistant appeared and asked to take him back to an x-ray room alone at first, then she would call me to a room.
In the next office, my son waited for me, spinning around in the rolling chair and laughing happily excited to hear that he needs braces.
When the moment of truth was told, the braces would cost $5,000, and a co-pay of $2,500 was expected up front before any treatment began.
I felt crushed by the weight of the growing and mounting medical debt we already accrued for my son's specialist care.
Dealing with disappointment.
My son jumped up and down at the exciting news anticipating the opportunity to have braces! He didn't really know what braces are because no one else in the family has them. It was just the point that he would be getting something that really made him feel special. But with the news about the cost of braces, I had to break the disappointing news to him that braces weren't free. There was just no way we could come up with $2,500 any time soon, never mind the latter half of the expensive costs.
When the orthodontist left the room to give me time to think about it, I started asking the assistant some basic questions.
- What types of insurance do you take?
- Do you have a payment plan?
- Does insurance pay any of it?
To which the assistant responded that my child is my responsibility and braces are not free. She went on to tell me that I should seriously think about placing his priorities first so he can get the braces he needs.
Offended and deeply troubled, of course this woman did not know our situation, but how dare she imply I didn't put my son's needs first? In fact, how dare she say that with a straight face while trying to charge me $5,000 for which they didn't accept insurance?
All hope is not lost.
With the estimate for the orthodontic treatments, I was handed a brochure. It was from the Smile for a Lifetime Foundation.
It's my understanding that Smile for a Lifetime Foundation operates in 33 states around the United States. They sponsor orthodontic care to children through pro-bono orthodontists.
To apply, one must do the following:
- Fill out an application
- Provide two letters of recommendation
- Send in a 5.x7 color photograph of the child's face, with a smile and teeth clearly visible
Because there are more than 80 chapters of this organization, the requirements may differ from one orthodontist to the next. For example, a quick search online for Smile for a Lifetime Foundation uncovered one chapter that requires the child to perform a certain number of community service hours to pay forward the opportunity they received through this program.
There is also a set of qualifications a child must first meet in order to apply:
- Must be a resident of a certain area
- Must be under the age of 18
- Must have income limitations or demonstrate financial need
- Must have a significant aesthetic need for braces.
Again, these may vary depending on the orthodontist.
Grateful yet troubled by this news.
My curiosity got the best of me because there are two things in life that I do not tolerate well.
- Being told it's not possible.
- Being told there is nothing else available.
When I'm told that something is either not possible or I don't have a choice in the matter, I always prove them to be wrong.
I don't want to be told it's impossible. Life is about opportunity. It saddens me when people are limited not by their own abilities, but because someone else says so.
Well, I challenged this idea that there is nothing else available to children besides their parents facing hardship by shelling out $5,000 for braces. After all, what if the parents have more than one child that needs braces?
Believe this. You always have a choice!
I've always believed in the idea that we all have more than a choice at any given time. There may be challenges and obstacles in our path. It's up to us to choose to move over that and keep going.
That attitude guided me on a three-week long research project which led me here. I did have some detours and road blocks to accomplish what I set out to do, but with a little perseverance I found the answer.
Connecticut is generous toward children with special needs. There is a hidden gem for parents that are struggling, especially when medical bills are out of the reach of many families that have children with Autism. When a child has Autism in Connecticut, and normally a family would not qualify for state insurance for the child because of income limitations, there is an exception for when a child's medical bills are grossly in excess over those of other children who do not require as much specialized care.
I am not an expert on state insurance by any means. There are offices around the State of Connecticut that can help parents get started. For example, many divorced parents may be eligible for state insurance for a child with special needs even when they do not feel they meet the income qualifications. So, when parents find themselves in a hardship to provide braces for a child with Autism, Connecticut offers a possible opportunity.
I spoke to the experts personally and am going to sum it up here for you in this article.
Connecticut offers hope to families with state insurance.
This pertains to all families in Connecticut on state insurance, but I want to discuss different circumstances here:
- If your family already receives state health insurance for your children and you find out your child needs braces, your child may be 100% covered under state insurance.
- If your family has a child with Autism and you have private insurance, you may be eligible for state insurance based on your child's health needs. If you haven't done so already, contact your local state insurance office to see if you would qualify based on income and other needs of the child.
- If your family has a child with Autism and you already have state insurance, your child may qualify for free braces.
State insurance covers 100% of the cost of braces when an orthodontist scores the child's teeth 24 points or higher. That score demonstrates a severe need for braces.
I had no idea that there is financial help available for braces in certain circumstances.
How to qualify for braces through state insurance.
One would think that it would be fairly easy to access dental offices throughout Connecticut. But when you are working with an office that accepts state insurance, finding an available one can become tricky.
The first place to start if you have state insurance already is to call 1-855-CT Dental or 1-855-283-36825.
If you don't have state insurance at this time, the customer service representatives that operate that phone number will be able to transfer you or assist you upon your call.
The customer service representatives are going to give you the names of dentists in your local area that accept state insurance. Have paper and a pen ready to write down the information.
By this time, you either know or don't know whether your child needs braces. You may have possibly been referred to an orthodontist previously, but that orthodontist doesn't accept state insurance. Therefore, if your child is special needs or your family receives state insurance, help may be available. It's just a matter of finding an orthodontist that accepts state insurance. The evaluation will determine whether or not your child qualifies based on the severity of the teeth.
Dentists that do not accept state insurance most likely will not know any orthodontists that accept state insurance. Therefore, start calling the dentist offices that accept state insurance. When I was doing this research, the first dentist was helpful. I didn't have to call anywhere else. (If your child is already seeing a dentist that accepts state insurance, but the issue of braces has never come up, simply ask at your child's next appointment if an orthodontic evaluation is necessary to determine if your child qualifies for braces covered by state insurance.)
While on the phone with the dentist that accepts state insurance, ask how your child may receive an evaluation by an orthodontist to determine if they are qualified for braces through state insurance.
The dentist office will give you the names of orthodontists in your area that accept state insurance.
There are not as many orthodontists that accept state insurance as there are that accept private insurance. Finding one can be tricky. As I found out through researching this topic, many orthodontists that accept state insurance are not taking new patients. So finding one locally and close to you may be challenging. You may need to find someone outside of your local area. But do not lose hope. They are out there.
In fact, I wanted to see how difficult it would be to find an orthodontist that accepts state insurance. I started calling dentists that advertise that they accept state insurance. Once I found dentists that accept state insurance, they gave me the numbers to area orthodontists that accept state insurance as well. It really was just a matter of finding dentists that take the insurance and they helped me locate the orthodontists.
When you get the numbers to orthodontists that accept state insurance, make an appointment.
At the appointment, the orthodontist will conduct an evaluation. A number system scores the child's teeth. If the child's teeth score above 24 points, the child will qualify for braces and state insurance will cover 100%. If the child's teeth score less than 24 points, then the need isn't severe enough for state insurance to cover.
What does this mean?
The state insurance program is not all-inclusive when it comes to braces. Your child's teeth must qualify for them.
But it's all or nothing. The state insurance program will not pick up a partial expense. They either pay 100% or they don't. And it's all based on this score that the orthodontist places on the severity of your child's teeth needs during the evaluation.
This information was obtained directly from various sources including Connecticut state insurance and several local dentist offices. It is subject to change. Please call and find out what your insurance covers before agreeing to out-of-pocket costs for your child's braces.
Your child may qualify under Connecticut state insurance for 100% coverage of braces.
The qualification is determined by teeth severity, a number system used by orthodontists.
Qualification for braces is not determined by income, but rather the severity of the child's need for braces.
There is a credit card called Care Credit. Ironically, I found out about this because I rescued a dog to train as a therapy dog for my son with Autism. At the first vet appointment, I was introduced to a Care Credit credit card application. Care Credit is not a major credit card such as Visa or Mastercard. However, it is often accepted at dentists, orthodontists, and animal vet offices.
While I'm not advocating for parents to go deeper in debt, Care Credit may be able to supply a line of credit to help pay for the braces if cash isn't available up front.
I also learned through my interviews of certain offices, that some orthodontists will accept payment arrangements. Some require half or all up-front before treatment begins.
So, if all else fails and state insurance will not approve your child for braces, there are still options out there although costly.
If you already have state insurance for your child, call and find dentists that accept it.
If you do not have state insurance, call your local state insurance office to find out if your child qualifies based on medical needs.
Once you have the numbers for dentists that accept state insurance, call and ask for the names and numbers of local orthodontists.
Make an appointment with an orthodontist that accepts state insurance for your child to have an evaluation for pre-qualification of braces.
If your child does not score high enough for state insurance to cover the cost of braces, there is financial assistance available such as payment plans, Care Credit Credit Card, or Smile for a Lifetime Foundation.
Did you know that financial help may be available for braces through state insurance?
The point of this writing this article is to help inform people in the State of Connecticut that otherwise had no idea that help may be available for their child.
I was personally not informed of this information when I sought help for my son's dental needs.
I hope someone out there can benefit from this knowledge and use it to get the help for their child that they otherwise would not pursue due to high costs.