HOW TO FILE YOUR VISION, DENTAL AND ORTHODONTIA CLAIMS

ORTHODONTIA CLAIMS

What to Submit

» Submit the treatment plans, invoices showing the entire amount you are responsible for and a detailed receipt.

» Also submit an EOB if you have primary dental.

» If the expense is for an adult, also submit a letter of medical necessity.

Remember Reimbursement Limits

» Orthodontic procedures are commonly performed on a multi-year contracted basis. How you pay that contract affects how you are reimbursed.

» If you pay for the entire contract upfront, you must submit this entire expense in that plan year for reimbursement, which will only be up to the plan year’s dental benefit limit.

» If you pay installments over the course of the contract, you will be reimbursed for those installments as they are made, up to the plan year’s dental benefit limit.

VISION CLAIMSDo you have a primary vision plan or vision coverage within your primary medical plan?

» Yes: Submit an Explanation of Benefits (EOB) for reimbursement with us. Include all pages of the EOB from your primary vision plan(s)including remarks such as footnotes and year-to-date (YTD) deductible summaries. An EOB is needed even if the charge is denied by the primary vision plan. If you have VSP as your primary plan, they do not provide an EOB but do provide a letter or statement of use. Please provide that in place of an EOB.

» No: Submit a detailed receipt that shows treatment/services received, date of service, patient name, provider name and amount paid. A cash or credit card receipt is not sufficient documentation. Please indicate that you have no primary coverage on the claim form and submit a detailed receipt and proof of payment for each service listed on the claim.

DENTAL CLAIMSDo you have a primary dental plan or dental coverage within your primary medical plan?

» Yes: Submit an Explanation of Benefits (EOB) for reimbursement with us. Include all pages of the EOB from your primary dental plan(s) including remarks such as footnotes and YTD deductible summaries. An EOB is needed even if the charge is denied by the primary plan.

» No: Submit a detailed receipt that shows treatment/services received, date of service, patient name, provider name and amount paid. A cash or credit card receipt is not sufficient. Please indicate that you have no primary coverage on the claim form and submit a detailed receipt and proof of payment for each service listed on the claim.

support@armadacare.com

Refer to your Certificate of Insurance for detailed information about coverage and your plan’s exclusions and limitations.

VDO072 07/18