Orthodontia Claims

[Guest R Jermier]

A participant has turned in a claim for $1860.00 for Orthodontia. The participant states that all but the monthly checks and removal have been performed. The bill says "mo. charges from 7/1/99 through 12/1/99" and that's all that it says. The Plan year starts 7/1/99. Is it ok to go ahead and pay the $1860.00? Do I need more documentation? It is difficult to get any kind of detailed statement from the dentist. What would you suggest?

[SLuskin]

I think that you need more documentation. We have seen orthodontic claims that show a large amount for impressions, records and putting the braces on, monthly fees for the monthly visits, and then something at the end for the retainer. I think that the dentist will cooperate when the client doesn't get reimbursed and you tell him/her that the dentist is the one holding us the reimbursement.