|
| GROUP NUMBER |
GROUP NAME AND PAYMENT PROCESS DETAILS |
| 00407 |
Parametric Technology Corporation
$ 750.00 lifetime orthodontic maximum for Basic plan
$1500.00 lifetime orthodontic maximum for High plan
Monthly payments. Patient receives full LTM regardless of prior history.
|
| 002397 |
MA Bricklayers & Masons
Effective 3/1/2010-transitions to our standard methodology of monthly
payments, paid in one plan year no longer 2 yrs.
Prior to 3/1/2010-Paid at 100%, $2600 LT M to be pay $1300 on the
Initial Banding date and the remaining $1300 paid 1 year after banding
date, as long as the patient is still eligible for benefits in that benefit
period which runs from July 01 to June 30 ($1300 Plan Year Max).
|
| 4309 |
NSTAR
Only Sublocations 7430-7432, and 9997 have a $1501 lifetime maximum that is
paid out as follows: Four payments that are each six months apart. First
payment is $760, Six months later a payment of $285, Six months later $228,
and the final payment six months later of $228.
All of their other sub-locations have an $1800 maximum.
These are paid monthly but must be submitted each month.
|
| 6318 & 4357 |
Boston Teacher's Union
Paid off a specific table-$2,000 lifetime orthodontic maximum paid in two payments, six months apart. Do not usually meet their maximum-$57 for each month of treatment plus $381 for records and banding.
Please note: Non-par is paid at a reduced fee. $45.60 for each month. $304.80 for records and banding. |
| 6563 |
Interstate Electrical
$1,500 lifetime orthodontic maximum-paid out in one payment. |
| 7525 |
The New England Carpenters (formerly Massachusetts State Carpenters)
$2,000 lifetime orthodontic maximum-paid out in one payment. |
| 4309 |
NSTAR
Only Sublocations 7430-7432 & 9997 that have a $1501 lifetime maximum that is paid out as follows: Four payments that are each six months apart. First payment is $760, six months later a payment of $285, six months later $228, and the final payment six months later of $228.
Please note: There are some NSTAR sub-locations that have an $1800 maximum. These are paid monthly but must be submitted each month. |
| 7007 |
Massachusetts Public Employees
Quarterly payments are based on length of treatment. Please submit a copy of the pre-estimate with date of service at the specified payment intervals to receive payment of orthodontic benefits. |
| DeltaCare |
All groups that have the DeltaCare product
Please submit a claim with the initial date of banding or date appliance is placed. Six months later please submit claim with date of service for remaining orthodontic benefits. |
