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Cost of orthodontic treatment and payment modalities

The cost of an orthodontic treatment depends on many factors, the main ones being:

  • Complexity of the case;
  • The patient’s age;
  • Anticipated treatment duration;
  • The type of appliances used to make the corrections.

At your first consultation visit, you will have an evaluation of the cost of treatment and you will be able to discuss it with us. A consultation report, confirming the cost and payment modalities, will be mailed to you. If you have a dental insurance covering orthodontic care, ask to receive an insurance predetermination form entitled “Certified Specialist in Orthodontics Standard Information Form” approved by the Canadian Association of Orthodontists. Certified Specialist in Orthodontics Standard Information Form approved by ACO_CAO (in French)

We will be pleased to review with you the various payment and financing options we offer to help you meet your budget. You will thus make financial arrangements with our office.

Orthodontic treatment fees do not include cleanings, extractions, restorations, surgeries, gingival care (periodontics), TMJ therapy (unless otherwise specified) as well as any restoration treatment necessary during or after the treatment. The cost of treatment includes a retention follow-up for which duration will vary according to individual characteristics of treated malocclusions.

Insurance coverage for orthodontics

  • Insurance for orthodontic care is often a separate benefit within a dental insurance contract.
  • If you have a dental insurance plan, you must verify with your insurance company if benefits are payable for orthodontics and which people are covered.
  • Children (dependants) are often covered up until a certain age, but adults can also be covered.
  • Refundable benefits usually cover a percentage of orthodontic fees and include, most of the time, a maximum amount.
  • Remember that the insurance coverage is determined by the insurance company and not by the orthodontist.

Determination of benefits

To determine the benefits you are eligible for, you must communicate with your insurance company or talk to your plan administrator and ask the following questions:

  • Does your plan cover orthodontic treatments (braces)?
  • Who is covered (children, adults, yourself)?
  • What is the maximum refundable allowable amount for an orthodontic treatment?
  • What is the percentage of coinsurance that is reimbursed? For example, if the maximum allowable amount is 2500.00$ and the coinsurance requirement is 50%, this means that it takes 5000.00$ of orthodontic care to receive the maximum allowable amount of 2500.00$.
  • Are diagnosis fees (complete examination) considered under a different banner than orthodontic care? If it is the case, the examination and diagnosis fees can be reimbursed at a different rate.

Note: When you talk to a representative of the insurance company, make sure to note his/her name and coordinates. This can facilitate future communications with your insurance carrier.

If you have insurance for orthodontics, we will give you the form entitled “Certified Specialist in Orthodontics Standard Information Form” that you will send to your insurance company by sending along a standardized Dental Claim Form (provided by your insurance carrier).

Insurance guidelines from the Canadian Association of Orthodontists (for the patient)

The following are guidelines to assist patients in obtaining in advance confirmation on the orthodontic insurance predeterminations:

  • Complete a Dental Claim Form in the usual manner.
  • Complete the “Patient Identification” portion of the Certified Specialist in Orthodontics Standard Information Form that you will receive from your orthodontist.
  • Attach the white (original) copy of the Certified Specialist in Orthodontics Standard Information Form to your Dental Claim Form. 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 2-3 weeks, it is suggested that you give them a call.

Submission of a claim

The following guidelines apply to examinations, diagnostic records and ongoing active treatment.

Fees for examination and diagnostic records

Attach the receipt provided by the orthodontic office to the Certified Specialist in Orthodontics Standard Information Form. Attach these items to your Dental Claim Form and submit it to your carrier. It is not necessary for the orthodontist to complete the Dental Claim Form. NO CODES ARE REQUIRED FOR ANY ORTHODONTIC CLAIM SUBMISSION.

Fees during an ongoing active treatment

The orthodontic office will provide you with a receipt when you make a planned payment. Attach that receipt to a Dental Claim Form and submit it to your carrier.

The coverage of your insurance carrier and benefits that you are eligible for were already pre-determined. Thus your orthodontic office does not need to provide any insurance forms at this point, only receipts. Thus there is no need for any further monthly or quarterly Standard Insurance Forms from the orthodontic office once you have received approval of the treatment plan from the insurance company. The receipt attached to your Dental Claim Form is sufficient proof of the continuation of treatment.

It is suggested that the subscriber keep a photocopy of all receipts submitted to the carrier. Thus any unpaid portion may be claimed as a deduction on your income tax return.

Source: CAO ORTHODONTIC ‘INSURANCE GUIDELINES (For Patients) 
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Points to remember:

  • Insurance companies do not pay orthodontists directly. Assigned payments are issued to the beneficiaries (patients);
  • Only one Certified Specialist in Orthodontics Standard Information Form is necessary to predetermine benefits;
  • Once benefits are known and approved, no other insurance forms are necessary from the orthodontic office.

Co-ordination of benefits

In a situation where two insurance subscribers both have orthodontic coverage, the person with the birthdate earlier in the year (e.g.: January vs July) is considered the primary or first subscriber.
The primary subscriber thus determined sends in the documents as outlined above to his/her carrier.
Then, the reply from the primary carrier is sent to the secondary carrier for adjudication.
You will find more details on insurance for orthodontic treatment and the process of submitting insurance claims on the Canadian Association of Orthodontists’ site.

Medical expenses tax credit

In Quebec, if you have paid an amount for medical expenses exceeding 3% of your net income and, the case being, the one of your spouse, you can get a non-refundable tax credit if you meet certain conditions determined by Revenu Québec.

Consult Revenu Québec’s site to learn more on the most common medical expenses and the maximum family income allowing for a tax credit. Click on this link: http://www.revenuquebec.ca/en/citoyen/credits/remb_maladie/default.aspx

  • To learn about the most common medical expenses eligible for a tax credit, follow this link: 381- Medica expenses
  • You can also download a document that provides the list of medical expenses eligible for a tax credit. Follow this link: Medical expenses.PDF http://www.revenuquebec.ca/en/sepf/publications/in/in-130.aspx
  • A brochure published by the Association des chirurgiens dentistes du Québec on tax credits for medical expenses with excellent examples applying to dentistry is available. For corporative reasons, the ACDQ asked us not to make the French brochure available.

In Canada, a non-refundable tax credit for medical expenses is also available. Consult the Canada Revenue Agency’s site to get more details. Follow this link: http://www.cra-arc.gc.ca/tx/ndvdls/tpcs/ncm-tx/rtrn/cmpltng/ddctns/lns300-350/331-eng.html


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