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All You Need to Know About Orthodontic Insurance

By November 22, 2017July 25th, 2024Orthodontist Pricing in Vaughan

Did you know that orthodontic coverage is often a separate benefit within your dental insurance contract? So how do you know if you have coverage? You can call your insurance company, or speak with the plan administrator and ask the following:

  1. Is there orthodontic coverage on the plan?
    If the answer is YES…
  2. What percentage is covered?
  3. What is the maximum (either annual or lifetime) benefit?
    Are there any limitations for the coverage (Age restrictions? Any deductible?)
  4. So… you have orthodontic coverage on your plan, and you begin your journey towards that Oscar winning smile with your orthodontic specialist; Now what?!

Submitting your orthodontic claims to your insurance company can sometimes seem complicated, especially because orthodontists do not accept assignment of payment from insurance companies like your general dentist, and because claims cannot be submitted electronically like most general dental practices can do.  While it is the obligation of your orthodontic office to provide you with a CAO or “predetermination” form, it is your obligation to submit your monthly claims to your insurance company for reimbursement.

Step 1: Upon deciding on a treatment plan and financial structure with your orthodontist, you must send a predetermination to your insurance company. Some orthodontic offices will do this on your behalf, if not they should provide you with the completed form.

FYI: The predetermination provides your insurance company with a brief description of your orthodontic condition, the treatment length, as well as the financial arrangement you have decided on.

2-3 weeks after mailing in the predetermination you should receive a response from your insurance company – if not, call them and make sure they have received it.

Step 2: As you receive your monthly receipts for your scheduled payments, you will send your claim along with the receipt to your insurance company (some companies even allow you to make your claim online!). Your insurance company will reimburse you directly.

It’s that easy!