Insurance Plans & Coverage
We are happy to assist you in claiming orthodontic benefits to which you may be entitled to under your dental insurance programs. To facilitate processing your claim we have adopted the following procedures.
WE will provide you with a Standard Information Form as approved by the Canadian Association of Orthodontists. This will contain a brief description of the condition, proposed treatment and financial arrangements.
YOU will need to complete the top right hand corner of the form. One copy is for the insurance company; the second copy is for your records.
When you make a payment to us, we will provide you with a receipt. Send the receipt to the insurance company along with the claim form and they will reimburse you according to your agreement with them.
This claim form is the only form you will require for orthodontic treatment; it will be valid for the duration of the treatment time. No other form will be necessary unless there is a change of treatment, which necessitates a change in the fee.
PLEASE BE SURE:
- You know what your benefits are before you begin treatment. If you are not certain, contact your insurance carrier so that you know exactly what percentage is covered, the lifetime or yearly dollar limit, and when you can expect payment.
- You understand that your payments are made directly by you to our office. The insurance company or carrier should reimburse you according to the terms of your contract with them. Your proof of payment to the orthodontist will be the receipt provided when payment has been made.
- You must inform us if double insurance coverage exists so that two claim forms can be prepared. Be advised that maximum benefits cannot legally exceed 100%. The percentage of liability of each company is a matter to be decided by the companies involved.
Your insurance company or carrier is responsible to you as set out in the policy.
If your employer offers Dental Care Insurance, read the specifics of your policy carefully. Please note that employer-sponsored Dental Care Insurance:
- covers only what your employer has agreed to cover (orthodontic treatment may not be covered). If you have coverage, the maximum covered is usually 50 percent of the treatment costs, with a lifetime maximum that varies.
- may not reimburse a lump sum payment. Check your policy.
- covers you only while you are employed with that company. If you change jobs and your coverage is lost, you are still responsible for payment of the treatment.
Your insurance company WILL NOT PAY the full benefit in one payment as the benefit is based on your continued employment. Instead, they allow approximately one-third of the total fee as an initial payment and the remaining fees, on a monthly basis over the duration of the active treatment time. Fees and a suitable payment plan will be arranged by our office.
If you change employers during your treatment, your new insurance company will pro-rate the fees and continue to reimburse you from the effective date of the new plan. Please inform us if you have a change of insurance company as you will require another standard information claim form.
Key points to consider:
- Orthodontic benefits are categorized under plan "C".
- In situations with DUAL insurance, the primary policy holder is the parent whose birth month comes first in the year (not necessarily the older parent). If there are more than two plans because of blended families, there is a particular order to the reimbursement protocol, which we can discuss with you if required.
- Our office does not accept assignment of payment directly from insurance companies, although we will be happy to assist you in completing a Standard Information Form, in order that you may be reimbursed directly.
- All dental insurance companies, with the exception of Pacific Blue Cross, allow for 33% of the total fee to be paid at the start of treatment (the day orthodontic treatment begins). The remaining fees are then paid on a monthly basis at a rate or approximately $200-$400 per month, until the account has been paid in full. For those clients covered by Pacific Blue Cross, the maximum initial payment is 50% of the total fee, followed by the same monthly payment schedule.
- Please be advised that should you elect to pay the fee in advance of the outlined payment schedule, your insurance company will NOT reimburse you all at once, but will stagger the payments as indicated above.
- Where dual insurance coverage is in place, the secondary insurance benefit company will require a copy of the primary insurance company’s reimbursement statement before making a payment to you. Consequently, you should submit your receipts to one plan at a time unless both plans are with the same insurance company.