Orthodontic Policy Regarding Insurance Coverage
for Orthodontic Services

Insurance Form
Patient Form
Privacy Notice

My staff and I would like to help you use any insurance benefits available to you if you have orthodontic coverage. If you will do the following, before you come to our office. For your examination appointment, we will be able to process your claim quickly and efficiently.

1. Please check with your employer's insurance clerk and verify that you have orthodontic coverage. Your benefits depend on the contract your employer purchased from the insurance company. We have no way of knowing until the insurance company responds to claim.
2. If there is any orthodontic insurance please fill out insurance information sheet that is attached.
3. Please provide us with your insurance card so we can make a copy for your file.
4. If more than one insurance company is involved, we need information each one.
5. If your insurance carrier changes or your insurance is terminated at any time, it is your responsibility to notify us. If your insurance is terminated, it is your responsibility to pay the balance.