Get the free Continuous Orthodontic Coverage Form - calstate

This document provides information on how to qualify for continuous orthodontic coverage when switching to DeltaCare USA and includes a form to submit for enrollment under this plan.

How to fill out continuous orthodontic coverage form

How to fill out Continuous Orthodontic Coverage Form

1. Obtain a copy of the Continuous Orthodontic Coverage Form from your orthodontist or insurance provider.
2. Fill out the patient's personal information at the top of the form, including name, date of birth, and contact details.
3. Provide details of the orthodontic treatment being administered, including the type of appliances used and the duration of treatment.
4. Include the name and address of the orthodontist overseeing the treatment.
5. Indicate the insurance policy number and the group number if applicable.
6. Attach any necessary documentation, such as treatment plans or prior authorization letters.
7. Review the completed form for accuracy and sign where required.
8. Submit the form to your insurance provider according to their specified submission guidelines.

Who needs Continuous Orthodontic Coverage Form?

1. Patients currently undergoing orthodontic treatment who wish to receive continuous coverage from their insurance.
2. Parents or guardians of minors receiving orthodontic care.
3. Orthodontists who need to provide information for their patients' insurance claims.

People Also Ask about

What qualifies as medically necessary orthodontia?

Medically necessary orthodontic treatment involves the correction of the dental component of a craniofacial abnormality that results in a Handicapping Malocclusion and is intended to restore a functional dentition.

What is the standard orthodontic coverage?

While standard dental insurance typically covers preventive care at 100% and basic procedures at 80%, orthodontic coverage usually pays just 50% of costs up to a lifetime maximum — often between $1,000 and $3,000 per person.

How to get orthodontics covered by insurance?

Steps to Make Sure Your Braces Are Covered by Insurance Check Your Policy Details. Talk to Your Insurance Company. Confirm Medical Reasons. Choose Covered Providers. Get a Pre-Treatment Estimate. Get Pre-authorization if Needed. Understand Your Out-of-Pocket Costs. Keep All Your Records.

Are orthodontics ever covered by insurance?

Braces are typically covered by dental insurance, but there can be exceptions. In some cases, medical insurance might cover braces if they are deemed medically necessary. This means braces are needed to correct a problem that affects your overall health, not just the appearance of your teeth.

How do I know if my insurance covers orthodontics?

You can review the dental plan materials to learn about covered and non-covered services, such as braces and other orthodontic treatments. Full-coverage dental insurance plans, for instance, often include orthodontic insurance coverage.

What is standard orthodontic coverage?

Orthodontic coverage typically involves a Lifetime Maximum (LTM) Benefit that pays out at 50% of the total case fee. There are a few plans that pay more or less than 50% this means that they will pay for braces 1 time and once you have used all the LTM they won't pay any more.

How much does dental insurance cover braces?

Dental plans that offer coverage for braces typically cover 50% of the cost, up to a $1,500 maximum. However, policies vary in coverage and caps.

What is the average cost of braces after insurance?

If you don't have insurance, metal or ceramic braces usually cost between $2,750 and $7,000. The cost of braces with insurance is typically between $1,638 and $4,933 for the full process. The cost for you will depend on your age, insurance plan and the type of braces you wear.

For pdfFiller’s FAQs

What is Continuous Orthodontic Coverage Form?

The Continuous Orthodontic Coverage Form is a document used to provide information about ongoing orthodontic treatment for insurance purposes, ensuring that patients receive appropriate coverage.

Who is required to file Continuous Orthodontic Coverage Form?

Dentists or orthodontists providing treatment typically file the Continuous Orthodontic Coverage Form on behalf of the patient to allow insurance providers to acknowledge the ongoing treatment.

How to fill out Continuous Orthodontic Coverage Form?

To fill out the Continuous Orthodontic Coverage Form, you should provide accurate patient details, description of the orthodontic treatment, treatment dates, and any other required insurance information as specified by the insurance provider.

What is the purpose of Continuous Orthodontic Coverage Form?

The purpose of the Continuous Orthodontic Coverage Form is to document ongoing orthodontic treatment so that insurance companies can process claims and ensure that the necessary coverage is provided during the treatment period.

What information must be reported on Continuous Orthodontic Coverage Form?

Information that must be reported includes patient demographic data, treatment start and expected completion dates, type of orthodontic appliances used, and any previous treatments that may impact the current coverage.