Claiming Your Ortho Insurance
Claiming Your Orthodontic Insurance
To claim your benefits as quickly as possible, please follow the instructions below. While we do not have a direct relationship with your insurance company, we will be glad to help you where we can. With most insurance companies, your orthodontic claim will be processed quicker if you submit the receipts with a dental claim form.
We also recommend that you keep a copy of the receipt for your own records.
Claiming for Orthodontic Examination or Records and Consultation
You do not need an orthodontic insurance form to claim for the initial examination or records and consultation. To get reimbursed for these costs, submit your orthodontic receipt along with a standard dental claim form to your insurance company, and put the following information on the claim form:
• group number
• identity number (usually the member’s social insurance number or employee number)
• patient dependent number (if through Pacific Blue Cross only)
• patient's birth date
• patient’s address
• your phone number in case your insurance company has any questions
Claiming for Active Orthodontic Treatment
Fees for active orthodontic treatment are usually divided into an initial fee and post-dated monthly or quarterly fees. The initial fee is due when active treatment begins. At that time, we will give you an Orthodontic Standard Claim Form. The insurance companies will not change payment schedules during treatment, so make sure the payment plan will work for you.
If you have coverage from two insurance plans, be certain to ask us for two Orthodontic Standard Claim Forms. Please let us know in advance so we can have the forms ready for you when treatment starts.
If your insurance company requires one of their own insurance forms (called a Standard Dental Claim Form), you can get one from your place of employment or download one from your computer from your insurance company’s website (e.g. Pacific Blue Cross under "dental claim forms"). Please attach it to the Orthodontic Standard Claim Form (the one you get from us),
Fill out the part of your Standard Dental Claim Form that applies only to Patient Section and Employer section. Do not fill in the doctor information section (as we do not go by general dentistry codes). The only information regarding the doctor section you need will be attached to our Orthodontic Standard Claim Form. Make sure you do not sign at the benefits assigned to dentist line (in the top right corner), just cross it out. This will ensure that the insurance reimbursement cheque will be forwarded to you and not us.
Make a copy of the all forms and receipts for your own records.
Send the Orthodontic Standard Claim Form and Standard Dental Claim Form along with any receipts directly to your insurance company or companies.
As your monthly or quarterly post-dated cheques are processed, we can email them to you or we will hold your receipt for you to pick up at the next scheduled appointment (unless you come and pick it up sooner). Submit the receipts (including all the information listed above) as you receive them. A new Orthodontic Standard Claim Form is not needed each time a monthly payment is processed but a Standard Dental Claim Form is required.
Claiming On Two or More Plans
If you have two insurance plans, ask us for two copies of the receipt.
1. Send the first receipt to the plan of the parent with the earlier birth date (MM/DD) in the calendar year. This is considered the "primary coverage". In the event that both parents have the same birth date, primary coverage belongs to the plan of the parent whose first name begins with the earlier letter in the alphabet.
2. After you receive payment from the first plan, send a copy of the insurance payment stub along with the second receipt to the second insurance plan.
** In situations of separation or divorce, submit receipts in the following order:
i. The plan of the parent with custody of the child (custodial parent)
ii. The plan of the spouse of the custodial parent
iii. The plan of the parent not having custody of the child (non-custodial parent)
iv. The plan of the spouse of the non-custodial parent
When separated/divorced parents have joint custody of a dependent child the insurance company uses the "birth date rule" (primary coverage falling under the plan of the parent with the earlier birth date) to determine the order of coverage or the parent whose first name begins with the earlier letter in the alphabet when the parents have the same birth date.
** It is vital to include the following information regarding the other plan:
• name of carrier
• group number
• identity number
• orthodontic (plan C) percentage
** In the event there are more than 2 parents involved, the payment order for children is as follows:
i. The parent with the earlier birth date in the calendar year
ii. The parent whose first name begins with the earlier letter in the alphabet when the parents have the same birth date
iii. The spouse of the natural parent with the earlier birth date
iv. The spouse of the natural parent with the later birth date
If you have any problems regarding insurance, please contact our office and we will be happy to assist you.