Financing and Insurance: Costs and conditions
COST OF TREATMENT & PAYMENT TERMS
The cost of an orthodontic treatment depends on several factors, the main ones being:
✪The complexity of the case;
✪The age of the patient;
✪The estimated duration of the treatment;
✪ The type of orthodontic appliances used to make corrections;
From your first visit you will have an estimate of the cost of the treatment and can discuss it with us.
If you have dental insurance covering orthodontic treatmentyou be provided with a predetermination insurance form entitled "General Information Form for Orthodontic Specialists" approved by the Canadian Association of Orthodontists.
It is with pleasure that we will review with you the various financing and payment options that we offer in order to accommodate your budget. Please note that we provide a courtesy discount to families with several children in treatment, as well as to patients who wish to make a full payment for their treatment.
The fees of orthodontic treatment does not include cleanings, extractions, fillings, surgeries, gum care (periodontics), joint therapy (unless otherwise specified) as well as any restorative treatment necessary during or after treatment. The cost of treatment includes follow-ups, the duration of which will vary depending on the individual characteristics of the malocclusion treated.
PROCEDURES WITH INSURANCE
- Source: http://cao-aco.org/ORTHODONTICINFO-FRE/insurance.asp -
Insurance for orthodontic treatments often a separate benefit inside a dental insurance contract. Coverage for orthodontics is usually around 50%.
In order to determine the benefits to which you are entitled, it is suggested to call the insurance company or speak to the administrator of your insurance plan where you work and ask them the following questions:
1 - Does the plan cover orthodontic treatments(braces)?
2 - If yes, at what percentage?
3 - Are there any limits to this coverage (such as age, maximum allowance etc.)?
Once you have determined that you are insured for orthodontics, you must make financial arrangements with your orthodontist. He must then provide and complete the general information form for orthodontic specialists as approved by the Canadian Association of Orthodontists. Send this form to your insurance company as soon as possible. Your insurer will let you know the benefits to which you are entitled. When you make a payment at your office orthodontist, you will be given a receipt which you will attach to one of your dental claim forms (to be completed by the insured himself). You will submit everything to your insurer who will reimburse you directly.
Orthodontists do not accept payment directly from insurance companies.
The orthodontist does not need to complete a dental claim form since there are no dental procedure codes required for insured orthodontic care.
Only one standard information form from a certified orthodontic specialist is necessary to determine the benefits. Once these benefits are recognized and approved, no other insurance form is required from your orthodontist's office.
CANADIAN ORTHODONTISTS ASSOCIATION INSURANCE DIRECTIVE
- For the patient -
The following are guidelines to assist patients in obtaining confirmation of orthodontic services insured:
1 - COMPLETE the "patient identification" section appearing on the General Information Form for Orthodontic Specialists that your orthodontist will give you.
2 - TO ATTACH a white copy of the General Information Form for Orthodontic Specialists. Submit everything to your insurer.
Your insurer will inform you directly, in writing, of the amount and extent of the services insured.
If you have no news after 2-3 weeks, it is suggested to call them.
SUBMISSION OF A INSURANCE COVERAGE CLAIM
The following guidelines apply to exams, taking diagnostic equipment, and active treatment
Fees for examination and taking diagnostic material:
Attach the receipt you will receive from the orthodontist's office to the General Information Form for Orthodontic Specialists.
Attach this to the Dental Claim Form and submit it to your insurer.
The orthodontist does not have to complete the Dental Claim Form.
NO PROCEDURE CODE IS REQUIRED FOR A CLAIM FOR ORTHODONTIC SERVICES.
Fees for an active treatment.
Your orthodontist's office will give you a receipt when you make the payment. Attach this receipt to a dental claim form and submit it to your insurer.
The insurance coverage and the benefits to which you are entitled have already been determined beforehand. Consequently, your orthodontist's office does not have to provide an Insurance Form at that stage, He must only provide you with receipts. There is therefore no need for your orthodontist to provide you with a Standard Information Form during your monthly or quarterly payments once your insurer has approved the treatment plan. The receipt attached to your dental claim form is sufficient proof of continuation of treatment. It is recommended that the insured keep a photocopy of all receipts submitted to the insurer. Thus any unpaid portion can be claimed as a deduction on your tax declaration.
If two insurance subscribers each have insurance covering the same person, the subscriber whose date of birth is the earliest in the year (eg January versus August) is considered to be the first or main subscriber.
The principal underwriter thus determined must send the forms mentioned above to his insurer.
Thereafter, the response of this first insurer is submitted to the second insurer for a decision.