We often get claims in at the end of the year that require additional information.
In some cases employees fail to get reimbursed because they don't have time to resubmit before their deadline.
To avoid this situation we recommend making your claims at least 2 weeks prior to the deadline and using our mobile app to submit. Also make sure you follow the 3 tips outlined below.
The Top 3 Reasons We Could Reject Your Claim And What You Can Do To Avoid These Mistakes:
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. The Orthodontic Treatment Plan is not being followed.
An Orthodontic Treatment Plan is a document that outlines your initial deposit and a payment structure. Often monthly instalments are the method selected.
We need this Orthodontic Treatment Plan to be included in your submission.
Furthermore, we need you to follow this plan when submitting to us. We cannot reimburse lump sums that do not match your Treatment Plan. If you are on monthly payments, we can only reimburse you on a monthly basis so make sure you submit those payment receipts as you go.
Additionally, if you have insurance coverage that is paying a portion of your orthodontic expense, please refer to point #1 because we still need the Explanation of Benefits included in your submission.