Orthodontia Guidelines
How to Pay for Adult & Child Orthodontia Using Your Health Care Reimbursement Account
Orthodontists typically bill for services one of two ways:
- Upfront deposit + monthly payments over the course of treatment
- Upfront payment in full
You can use any of the available payment features to pay for the orthodontic expenses incurred by yourself or any eligible dependent:
- Pay by Card
- Pay My Provider
- Pay Me Back
How to Pay for Orthodontic Expenses Using Your Health Care Reimbursement Account
| |
Ortho Billing Method |
Pay by Card |
Pay My Provider |
Pay Me Back |
| 1 |
Upfront deposit + monthly payments over course of
treatment |
Make each payment (deposit + monthlies) using your
Health Care Card |
Request a one-time payment from your account to cover
deposit; request recurring payments to cover monthlies |
Pay by cash, check or credit card; then, request
reimbursement for each payment |
| 2 |
Upfront payment in full |
Make payment using your Health Care Card |
Request a one-time payment from your account |
Pay by cash, check or credit card; then request
reimbursement |
| Both |
Which plan year will cover this expense? |
Plan year in effect when Card is presented for
payment |
Plan year in effect on the service date for each
payment |
Plan year in effect on the service date for each
payment |
Documentation Required for Approval
- Pay by Card: Submit contract at the beginning of each year.
- Pay My Provider: No documentation required.
- Pay Me Back: Proof of expense required with each claim.
- Only the portion of your orthodontic payment(s) not paid by your dental insurance or any other plan is considered an eligible expense.
- Find out in advance what portion the other plan will cover and pay for only the balance that you will pay out of your pocket.
- If your other plan pays more than expected after you have received reimbursement from your Health Care Reimbursement Account, then you are responsible for paying the "covered" portions back to your account.
- Paying with a Health Care Card, save the detailed receipt AND payment contract provided by the orthodontist. You will need this to verify your Card transactions,
submit a claim, and verify expenses in case you are audited by the IRS.
- Pay My Provider requests can be entered up to 10 days prior to the desired payment date (the day you want us to mail the check to your orthodontist).
- Setting up monthly recurring Pay My Provider payment requests is the easiest way to pay monthly orthodontic expenses. This method also ensures your orthodontic payments will be spread out across multiple plan years so you can make the most of your plan (given applicable maximum election amount).
If you paid a lump sum in the prior calendar year and were reimbursed a
prorated amount, the balance due can be reimbursed in the current plan year
(if you are still receiving orthodontia services) by providing a copy of the
payment information, claim form and a letter indicating the amount you were
reimbursed in the prior year.
How to Request Pay My Provider
Payment will be made in the amount requested as long as your available balance
will cover it. If not, no payment is issued to the provider.
- Log on to Your Personal Account and enter your User Name and Password (if you haven't accessed your account before, click on the "First Time User?" link and follow the simple process to register to use this site).
- Click on the Health Care tab
- Select "Request Pay My Provider"
- Confirm your contact information
- Enter your provider information. (Details are automatically saved for the next time you want to request a payment to this provider.).
- Enter the patient information and select the appropriate type of service (Orthodontia)
- Enter the payment information and the number of payments you wish to make (1 to 12). The minimum payment amount is $20.*
- Confirm your payment instructions.
- The check sent to your provider serves as verification of your expense, so no receipt or invoice is required from you to substantiate your claim.
How to Request Pay Me Back
You can use Pay Me Back to be reimbursed the amount you paid out-of-pocket towards the treatment in the current plan year.
To be reimbursed, follow the steps below and submit to WageWorks:
- Complete and sign a Health Care Pay Me Back claim form
- Include a copy of the monthly payment receipt, monthly payment coupon, detailed invoice or payment contract — whichever supports the amount being requested on the claim form.
- Make sure your proof of expense (one of those listed above) contains the following information: name of the provider, type of service performed, amount paid by the participant, and date the service was provided.
How to Get More Information
Online: www.hr.duke.edu/reimbursement
Phone: (877) 924-3967, Monday through Friday, 8 a.m. to 8 p.m. Eastern Time
*Note: Your payment will be made in full (up to the available balance in your account at the time this payment is
processed just prior to the requested payment date). You will be sent an email notifying you that another form of
payment to your provider is required if we are not able to make payment based on an insufficient balance.
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