Top 3 Tips For Year End Claiming

The end of the benefit year is busy, and we often get claims with the wrong documentation. In some cases, employees fail to get reimbursed because they don't have time to resubmit before their deadline. 

To help avoid this situation, avoid the 3 common mistakes outlined below. 

1. Insurance was involved and you didn't send us their 'Explanation of Benefits' 

Often we receive receipts that show that an employee has insurance coverage. This can be coverage from a group plan or a spousal plan.

Anytime we see that insurance is involved, we have to request the insurance company's 'Explanation of Benefits' (EOB) document.

This EOB document is given at the end of any claim you submit through your insurance. Often you can find it on your online account with the insurance carrier. We don't have access to this account and need you to submit the EOB to us because it confirms how much insurance paid (even if it is 0) but also the reason why (their applicable messaging). 

2. The receipt shows payment date when we really need treatment date

Just submitting a payment receipt does not tell us the information we need.

Make sure you get a detailed invoice that includes the date of the treatment and details of what the treatment was. 

For Dental Claims (if you do not have insurance coverage) send us the Standard Dental Claim Form. It includes all the information detailed above. 

Of course if you have insurance coverage, send us the Explanation of Benefits from your carrier instead (see point #1).

3. Your Orthodontic claim is missing information

For orthodontic treatment expenses submit a copy of each payment receipt. The payment receipt must clearly indicate the expense is for Orthodontics and what kind of expense it is (Deposit/Initial Payment/Monthly Installment). The receipt must include the patient name, amount and the date of the payment.

IMPORTANT: If you have any insurance or other coverage for orthodontic treatment, you must provide additional documentation. Your first orthodontic claim must include the Orthodontic Treatment/Financial plan, which shows the patient name and payment schedule you have arranged with the dentist. We will keep this plan on file so you will need to submit it only once.

When there is any insurance or other coverage for orthodontic treatments, you must submit the expenses to them first. They will process the claim according to the payment schedule and provide you with an Explanation of Benefits document (EOB, also sometimes called a Claim Statement). We require the EOB document for each payment you are claiming when other coverage has been involved.

Regarding lump-sum payments, please be aware that we cannot reimburse lump sum payments if there is any other coverage involved with your orthodontic claim. If you have other coverage, you must make payments according to the payment plan that your insurance company is following.