Financial Information

Payments

We are pleased to accept cash, personal cheques, Interac, Visa®, or MasterCard® as a form of payment. Once treatment is prescribed, we will provide you with a predetermination form that outlines the cost of treatment. The financial contract consists of an initial payment that’s due the day treatment starts, followed by monthly fees that correspond approximately to the length of active treatment.

Financial Questions/Arrangements

Our Financial Coordinator would be happy to answer any questions or concerns you have about financial arrangements. We are willing to make special financial arrangements; however, we would appreciate knowing beforehand so we can have the paperwork ready for you. Please feel comfortable discussing your special requests with us — your honesty is appreciated.

Orthodontic coverage is often a separate benefit in a dental insurance contract. Coverage for orthodontic treatment usually is at the 50% level.

To determine your orthodontic coverage, it is suggested that you call your insurance carrier or speak with the plan administrator where you work and ask the following questions:

  1. Does your plan cover orthodontic treatment?
  2. If so, at what percentage?
  3. Are there any limitations to coverage (e.g., age, maximum dollar amount, etc.)?

For Submission of Claims

Once you have established that you have orthodontic coverage, and after financial arrangements have been made with the orthodontist, it is the obligation of the orthodontic office to provide you with a Canadian Association of Orthodontists Certified Specialist in Orthodontics Standard Information Form (Predetermination).

  1. For consultations, X-rays, and diagnostic records:
    When payment is made to the orthodontic office, you will be provided with a receipt and a Certified Specialist in Orthodontics Standard Information Form. Attach these to your Dental Claim Form and submit it to your carrier.
  2. For submission of orthodontic insurance predeterminations:
    1. COMPLETE one of your Dental Claim Forms in the usual manner.
    2. COMPLETE the “Patient Identification” portion of the Certified Specialist in Orthodontics Standard Information Form that you receive from your orthodontist.
    3. ATTACH the Standard Information Form to your Dental Claim Form and submit it to your insurance carrier.
    Your insurance carrier will advise you directly, in writing, how much the firm will cover. If you do not hear back from your carrier within two to three weeks, it is suggested that you give them a call.
  3. For ongoing active treatment:
    The office will provide you with a receipt. Attach that receipt to a Dental Claim Form and submit this to your insurance carrier who will reimburse you directly. The orthodontic office does not need to provide any insurance forms at this point, only receipts, as the orthodontic treatment has been pre-determined already by your carrier.
  4. For co-ordination of benefits
    In a situation where two parties both have orthodontic coverage, the person with the birth date earlier in the year is considered the primary or first subscriber (e.g., January birth date as opposed to August). The primary subscriber sends in the documents as outlined, and then sends the reply from the primary carrier to the secondary carrier for approval.

Points to remember

  1. Orthodontists do not accept payment from insurance companies.
  2. It is not necessary for the orthodontist to fill in the Dental Claim Form because no dental codes are required for orthodontic coverage.
  3. Only one Certified Specialist in Orthodontics Standard Information Form is necessary to predetermine your benefits, and once approved, no other insurance forms are necessary from the orthodontic office.