Orthodontic Cost-Shares
For orthodontic services received CONUS, you are responsible to pay a 50 percent cost
share.
Orthodontic Payments
Orthodontists must submit to United Concordia an orthodontic treatment plan, which should include the type and length of the treatment and the total charge, for the patient. United Concordia will send notice of the treatment plan payment schedule to both the orthodontist and the patient.
If, during the course of treatment, there are any changes to the patient’s prescribed treatment plan that will result in a change to the payment schedule, the orthodontist needs to notify United Concordia. A revised payment schedule will be sent to both the orthodontist and the patient.
Orthodontic payment amounts and schedules are based on the projected length of treatment and are calculated as follows:
An initial payment equal to 25 percent of the total amount payable is made when bands are first placed.
The remaining 75 percent of the total amount payable is paid in quarterly installments, based on the length of treatment.
If the estimated length of treatment is six months or less, United Concordia’s payment will be made in one lump sum.
Payments for Treatment in Progress
If orthodontic treatment is already in progress when the patient becomes eligible for enrollment in the TDP, the initial payment depends on the enrollment date and the number of months of treatment remaining.
Note: If a member reaches the applicable age limit during
treatment, payments will be discontinued the month after their 21st or
23rd birthday, whichever applies.
Visit the
Orthodontics
section under Overseas Dental Care for information on OCONUS orthodontic care.
For further information on the CONUS orthodontic care, refer to the
TRICARE Dental Program Benefit Booklet
