Terms of orthodontic insurance coverage vary between insurance companies and individual policies. Because of this diversity, we make all financial arrangements directly with the patient/family.
We do not accept assignment of insurance benefits from your insurance company, similar to the vast majority of orthodontic specialists across Canada. Dental insurance policies are a contractual agreement directly between the patient and the insurance company. Therefore, all claims and reimbursements should be managed by the insured party, as recommended by the Canadian Association of Orthodontists. In addition, federal privacy laws do not allow insurance companies to divulge your policy information to third parties.
We will be pleased to provide you with the appropriate documentation to assist you in claiming the orthodontic benefits to which you may be entitled to under your dental insurance programs.
We recommend that you obtain the exact specifics of your orthodontic coverage within your dental insurance in order to be fully informed of your anticipated coverage and reimbursements. 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.
Most insurance companies 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. 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.