Filing claims for orthodontic treatments can be a real pain if you don't know what you are doing. Insurance providers have specific guidelines for the reimbursement of orthodontic claims as these treatments can span over multiple plan years. This makes processing these claims a complex task that requires some effort. Practices need to follow specific claim submission protocols to ensure that their claims get paid. If any of the information or documentation is incomplete or missing while submitting these claims, it can result in denials.
The first stage in the process is to determine patient eligibility for orthodontic benefits. For dental insurance verification and coverage, get in touch with the patient or insurance provider, as orthodontic benefits vary greatly between different policies. The various pieces of information that need to be verified include details that are verified for regular dental services, like the name and date of birth of the patient, the name and contact information of the insurance provider, and also the insurance policy number. The practice also needs to get in touch with the insurance provider so as to learn the lifetime maximum, the percentage of the premium that the carrier is responsible for paying, the copayment and deductible, as well as any restrictions like age and dependency status. Keep in mind that all this needs to be carried out before the patient’s appointment.
When a patient has dual coverage or is covered by multiple insurance plans, coordination of benefits becomes really crucial. Once the primary and secondary carriers are identified, claims need to be submitted in accordance with the rules that specify the sequence in which the dental practice must bill each health insurance plan.
While filing a reimbursement claim form that has been filled out completely, a statement outlining the treatment plan and the financial arrangements should be submitted. The documentation must include the estimated length of treatment, the payment plans, and the anticipated insurance payment, if any.
While these tips should generally help make the orthodontic claim preparation and submission easier and more streamlined, practices need to remember that each insurance provider could have specific requirements to accept orthodontic claims. Providers like Aetna and Delta Dental have their orthodontic claim submission requirements on their websites. Also consider that nothing can replace the eligibility and verifications process when ensuring that you prepare your claims accurately.