Office InfoFinancial & Insurance
At Marcy Orthodontics we believe that financial considerations should not be an obstacle to obtaining a healthy, beautiful smile. Being sensitive to the fact that people have different needs in meeting their financial obligations, we have various interest-free payment options and work hard to make orthodontics affordable.
The cost of orthodontic treatment depends on the severity of the patient’s problem and the length of time required to complete the treatment. You will be able to discuss fees and payment options with our staff at the consultation appointment prior to treatment. For your convenience, we accept payment by cash, cheque, Visa, MasterCard.
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 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 our office to provide you with a Canadian Association of Orthodontists Certified Specialist in Orthodontics Standard Information Form (Predetermination form).
1. For consultation, 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:
a. Complete one of you Dental Claim Forms in the usual manner.
b. Complete the “Patient Identification” portion of the Certified Specialist in Orthodontics Standard Information Form that you receive from your orthodontist.
c. 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 they 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:
Our 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. Our 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 provider 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 as 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.