Insurance

Insurance benefits are contigent on your employment and the benefits established between your employer and the insurance company.

Federal and Provincial Privacy Policies prevent the insurance companies from providing our office information about your benefits. Consequently, we ask that you confirm with your human resources department at work or directly with your insurance company, the following information:

• Do you have insurance benefits?
• Is the benefit for both children and adults, to what age?
• The benefit effective date or is there a waiting period?
• Lifetime maximum benefit available per person?
• The percentage % of reimbursement you will receive.

Your insurance company WILL NOT PAY the full benefit in one payment as the benefit is bases 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. Fees and a suitable payment plan will be arranged by our office.

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.

Key points to consider:

• Orthodontic benefits are categorized under plan “C”;
• In situations with DUAL insurance, the primary policy holder is the parent whose birth month comes first in the year (not necessarily the older parent). If there are more than two plans because of blended families, there is a particular order to the reimbursement protocol, which we can discuss with you if required;
• Our office does not accept assignment of payment directly from insurance companies, although we will be happy to assist you in completing a standard information form, in order that you may be reimbursed directly;

• All dental insurance companies, with the exception of Pacific Blue Cross, allow for 33% of the total fee to be paid at the start of treatment (the day orthodontic treatment begins). The remaining fees are then paid on a monthly basis at a rate or approximately $200-$400 per month, until the account has been paid in full. For those clients covered by Pacific Blue Cross, the maximum initial payment is 50% of the total fee, followed by the same monthly payment schedule;
• Please be advised that should you elect to pay the fee in advance of the outlined payment schedule, your insurance company will NOT reimburse you all at once, but will stagger the payments as indicated in point 4;
• Where dual insurance coverage is in place, the secondary insurance benefit company will require a copy of the primary insurance company’s reimbursement statement before making a payment to you. Consequently, you should submit your receipts to one plan at a time unless both plans are with the same insurance company.