• Canada Life
  
  

• Questions to ask:

  1.      What is the maximum coverage and % rate?

  2.      Is there an age restriction?

  3.      What is the 01901-records code covered at? And under what category? (ortho, basic, or preventive)

  4.      What is the maximum initial fee % the insurance will pay?
  
  

• What is the max initial fee Insurance will pay?
  35% but can vary based on plan. Ask during initial breakdown.
  
  
• Do you pay for the 01901 code?
  Depends on policy. Ask during initial breakdown.
  
  
• Does the 01901 code count against ortho limit or against the initial fee max?
  No!
  
  
• What is required for Insurance approval?
  Treatment Letter
  Treatment plan (total cost, down payment, length of time)
  
  
•   What if primary doesn’t cover ortho or it is maxed out. Do we have to send rejections every month?
  Send one EOB/ proof of payment max and GWL will update so all future claims can be sent out directly every month going forward.
  
  
•   What is the fastest way to get approvals?
  Mail (5-7 business days)
  Can get response over phone instead of waiting for physical approval to be returned.

• PBC

• Questions to ask:

  1.      What is the maximum coverage and % rate?

  2.      Is there an age restriction?

  3.      What is the 01901-records code covered at? And under what category? (ortho, basic, or preventive)

  4.      What is the maximum initial fee % the insurance will pay?
  
  

• What is the max initial fee Insurance will pay?
  50% most plans.
  
  
• Do you pay for the 01901 code?
  Yes part of ortho coverage.
  
  
• Does the 01901 code count against ortho limit or against the initial fee max?
  Yes.
  
  
• What is required for Insurance approval?
  Treatment Letter.
  Treatment plan (total cost, down payment, length of time).
  
  
•   What is the fastest way to get approvals?
  Mail (2-3 weeks)
  Can check online once approved.

• Sunlife
  

• Questions to ask:

  1.      What is the maximum coverage and % rate?

  2.      Is there an age restriction?

  3.      What is the 01901-records code covered at? And under what category? (ortho, basic, or preventive)

  4.      What is the maximum initial fee % the insurance will pay?

• What is the max initial fee Insurance will pay?
  40% but can vary based on plan.
  
  
• Do you pay for the 01901 code?
  Depends on policy. Ask during initial breakdown.
  
  
• Does the 01901 code count against ortho limit or against the initial fee max?
  Yes – most plans deduct from initial fee.
  
  
• What is required for Insurance approval?
  Treatment Letter.
  Treatment plan (total cost)
  Send Pan.
  
  
•   What if primary doesn’t cover ortho or it is maxed out. Do we have to send rejections every month?
  Submit documentation once regarding maximum reached by primary (EOB or Pre-D denial for ortho coverage by primary).
  
  
• What is the fastest way to get approvals?
  Mail (5-9 business days),
  Corresponds with member.
  Can call in to get approval.
   
  Note:
  Ortho coverage is non-assignment.

• Manulife
  

• Questions to ask:
  1.      What is the maximum coverage and % rate?
  2.      Is there an age restriction?
  3.      What is the 01901-records code covered at? And under what category? (ortho, basic, or preventive)
  4.      What is the maximum initial fee % the insurance will pay?
  
  
• What is the max initial fee Insurance will pay?
  No maximum on initial fee.
• Do you pay for the 01901 code?
  Depends on policy. Ask during initial breakdown.
  
  
• Does the 01901 code count against ortho limit or against the initial fee max?
  Depends!
  
  
• What is required for Insurance approval?
  Treatment letter.
  Duration of treatment.
  Payment plan details.
  Send Pan.
  
  
• What if primary doesn’t cover ortho or it is maxed out. Do we have to send rejections every month?
  Submit documentation once regarding maximum reached by primary (EOB or Pre-D denial for ortho coverage by primary).
  
  
• What is the fastest way to get approvals?
  Mail (5-7 Business days).
  Corresponds with member.Can get patient to get verbal approval over the phone.
   

• Empire Life

• Questions to ask:
  
  1.      What is the maximum coverage and % rate?
  2.      Is there an age restriction?
  3.      What is the 01901-records code covered at? And under what category? (ortho, basic, or preventive)
  4.      What is the maximum initial fee % the insurance will pay?
  
  
• What is the max initial fee Insurance will pay?
  No maximum on initial fee-entire life max can be paid all at once-depends on the individual plans.
  
  
• Do you pay for the 01901 code?
  Submit estimate or if we have a pt with ortho coverage through empire we can submit pred or call & confirm coverage.
  
  
• Does the 01901 code count against ortho limit or against the initial fee max?
  Submit estimate or if we have a pt with ortho coverage through empire we can submit pred or call & confirm coverage.
  
  
• What is required for Insurance approval?
  Treatment letter.
  Treatment plan (total cost, down payment, length of time).
  Send Pan.
  
  
• What if primary doesn’t cover ortho or it is maxed out. Do we have to send rejections every month?
  Request & submit letter from primary stating that it is maxed otherwise we would have to send EOB every time.
  
  
• What is the fastest way to get approvals?
  Mail (5-7 business days) since pan cannot be sent EDI

• Claim Secure

• Questions to ask:
  
  1.      What is the maximum coverage and % rate?
  2.      Is there an age restriction?
  3.      What is the 01901-records code covered at? And under what category? (ortho, basic, or preventive)
  4.      What is the maximum initial fee % the insurance will pay?
  
  
• What is the max initial fee Insurance will pay?
  No max on initial.
  
  
• What is required for Insurance approval?
  Treatment letter.
  Treatment plan (total cost, down payment, length of time).
  Send Pan.
  
  
• What if primary doesn’t cover ortho or it is maxed out. Do we have to send rejections every month?
  Requires EOB every time OR a letter from primary stating that the full max is reached.
  
  
• What is the fastest way to get approvals?
  Can fax: 1888-613-0503.
  
  
• Note:
  NO EDI FOR ORTHO CLAIMS!

• Green Shield

• Questions to ask:
  1.      What is the maximum coverage and % rate?
  2.      Is there an age restriction?
  3.      What is the 01901-records code covered at? And under what category? (ortho, basic, or preventive)
  4.      What is the maximum initial fee % the insurance will pay?
  
  
• What is the max initial fee Insurance will pay?
  35% of the initial fee.
  
  
• Do you pay for the 01901 code?
  YES!Covered if pt has ortho coverage.
  
  
• Does the 01901 code count against ortho limit or against the initial fee max?
  Yes-against ortho limit.
  
  
• What is required for Insurance approval?
  Length of treatment
  Total cost of treatment.
  No xrays required.
  
  
• What if primary doesn’t cover ortho or it is maxed out. Do we have to send rejections every month?
  Requires EOB every time OR a letter from primary stating that the full max is reached.
  
  
• What is the fastest way to get approvals?
  Mail (5-7 business days)
  
   

• Filling out of this section is not required by Align. However, having a problem list is the foundation of a robust treatment plan. Furthermore, this section allows you to search your patients list for a specific clinical condition. 
  
  
• A case could have more than one of the below mentioned clinical conditions. For example:
  Class II div 1 ; Crowding ; Deep bite.

• You can always choose "Comprehensive Package" to start. When you finish the ClinCheck review, if you see that treatment could be finished with 20 Aligners and one set of refinement (up to a maximum of 20 aligners), in your last modification you may ask Align technician:
  
  " Please downgrade the treatment option to Invisalign Moderate."
  
  
• For any reason, if you need one more refinement (a second refinements after the first set of refinement) your lab fee will still be less than a "Comprehensive Package".
  
  
• We also need to know that " Invisalign Moderate " will be open for 2 years from the shipping date of the first set of aligners while "Comprehensive Invisalign" will be open for 5 years.
  
  
• For difficult patients with high expectations or poor compliance it is wise to choose  "Comprehensive Invisalign"  even if the number of aligners in first clincheck is less than 20.
  
  
• "Comprehensive Invisalign" and "Moderate Invisalign" both have the same number of Advantage Points (1000 points) in Invisalign Advantage Program. If you start less than 3 cases in a month trying to get more Advantage Point does not have any financial benefits. 
  
  
• To be qualified for "Gold Tier", on average, you should start 4 comprehensive or moderate cases in each month. 

• As a general rule, we always try no to treat a single jaw. As the teeth move, bite changes and it could be a chalenging clinical condition. 
  
  
• Single jaw treatment of mild crowding of lower anteriors could easily lead to a failure. This problem is very common and could be seen in two types of patients:
  
  1- Patients without history of orthodontic treatment with generally accpeptable alignment/bite and minor cowding of lower incisors. This crowding begins to develop in late teens/early twenties and is called "Late Crowding". 
  
  2- Minor shift/relapse of lower incisors years after finishing the orthodontic treament.
  
  if these two types of patients have minimal/normal overjet, single lower jaw treatment could fail or cause a posterior open bite.  

• After considering the above mentioned limitations of single jaw treatment, if you decided to do a single jaw treatment, we advise to choose "Nothing on opposing arch".
  
  
• If you choose " Passive aligners on opposing arch", Align will charge you same as both jaw treatment.

• For mild crowding cases that we do not need to rely on expansion of posterior teeth and the posterior bite is acceptable, we can choose " Anterior Only".
  
  
• For moderate crowding cases, resolving the crowding with proclination and IPR only would be chalenging and we should consider posterior expansion as well.
  
  
• In many of deep bite cases, to open the bite, we need to extrude premolars and a "Full-Arch" treatment is needed. 

• We use this option when we cannot move a tooth like an ankylosed tooth, bridges or a periodontally compromised tooth.
  
  
• Align technicians do not make theses changes for you. They even could move an implant on a ClinCheck! It is your responsiblity to instruct them here.
  
  
• As we always emphesize, clicking the "NEXT" button without choosing the right answers to the questions of the prescription form will compromise the treatment results.  It is a very wrong belief that we can modify or ask somebody to modify the clincheck to correct the wrong answers that we give to the questions on pescriptions form. Prescription form is the founation of the treatment plan.
  
  
• Making a tooth "unmovable" does not mean that aligners will not apply force on it. According to the Newton's third law of motion, the reaction of the force aligner applies to the adjacent teeth will be applied on the teeth that we made them "unmovable" as well. That means if you have a periodontally compromised tooth and you made it "unmovable" it still be under force if we have significant tooth movement of adjacent teeth.

• Clinically it is difficult, or sometimes practically impossible, to bond attachments on metal crown, big buccal metal restorations, Zirconial crowns. Instruct the Align technician here. It is not a good idea to change it on ClinCheck
  
  
• Bonding on wisdom teeth and second molars could be chalenging in clinical settings.
  
  
• Do not take the risk of treatment without attchments even you have obtained a signed consent saying that patient will accept the risk of not having attachmensts. You will be responsible for the treatment results at the end. When you explain the function of attachments they usually accept that.

• Maintaining the A-P relationship will have the most predictable results.
  
  
• The option of "Correcting to Class I" in a full cusp class II patient could easily lead to a compromised posterior bite which will be difficult to manage. We expect over- expanded and bucully tipped upper posteriors teeth with a posterior openbite in full cusp class II patients that we asked for "correction to class I". 
  
  
• Do not try "Sequential Distalization" if :
  1- You do not have enough experience; or
  2- You are not sure about patient's compliance.
  
  In a non compliant patient, distalizing could cause multiple loose interproximal contacts with no or minimal improvement of overjet. Wearing the rubber bands is crucial and upper wisdom teeth should be pulled out before starting.
  
  
• Correcting a full cusp Class II to Class I without extraction is an exception not a rule.
  
  
• If the class II relationship is less than a half cusp (e.g. 3 mm of overjet), "Improve canine and molar relationship" will be a clinically feasible treatment option in compliant patients that will wear elastics.       

• As a rule of thumb, the final clinical overjet of patient will be significantly less than the final overjet on ClinCheck. If the overjet is minimal (1-2 mm) before treatment of crowding or the final overjet on ClinCheck is 1-2 mm, we have to expect heavy anterior bite and posterior openbite after treatment.

• Choose " Improving resulting overjet after alignment " when the above mentioned clinical condition is not a concern. for example in many non extraction class II patients, we choose this option to see how alignment will affect overjet/overbite.
  
  
• Choose " Maintain initial overjet " when developing a heavy anterior bite and posterior open bite is anticipated. For example: In a mild crowding of lower incisors with normal overjet we choose this option. In these cases a heavy anterior bite and posterior open bite could be developed if we do not consider IPR for lower anteriors.
  
  
• " Improve resulting overjet with IPR " will be an option for:
  
  1- Class II patients; IPR of of upper anteriors will decreasethe overbite.
  
  2- Very mild class III patients with edge to edge incisors. Patient should wear class III elastics. otherwise the anchorage loss happens and overjet would not be improved. Generally the results of this approach in mild class III patients is not predictable. 

• As a rule of thumb, the final clinical overbite of patient would be significantly more than the final overbite on ClinCheck. In a deep bite patient, when you see a normal overbite on the Clinicheck, the final overbite will still be deep after treatment. It can cause posterior openbite if lower teeth are crooked and the clearance between upper and lower anteriors before starting the treatment is minimal.
  
  
• We might choose " Show resulting overbite after alignment " in class II div 1 cases with moderate overbite or in class I cases with normal overbite. 
  
  
• we may choose " Maintain initial overbite(may require IPR) " in class I patient with minimal overbite and crowding. If we rely on proclination only to resolve the crowding, the bite might be opened after flaring(proclining) the anteriors. This is called "relative intrusion". That is why we need to consider IPR as weel to maintain the normal overbite  
  
  
• " correct open bite"  is to manage open bite cases. to manage open bite we can extrude anteriors and/or intrude posteriors. IPR of anteriors will help to have "relative extrusion"
  
  Do not try to manage moderate to severe open bites if you do noyt have enough experience.
  
  
  
• " Correct deep bite "  is predictable if you follow the built-in protocol in this form. We should know the "incisal show at rest" and also patient's "facial height".
  
  
• Incisal show at rest could be measured only when the patient is present. You cannot measure it on any records, X-rays,...
  
  
• Patient facial height could be measured on lateral cephalometry. However there clinical signs of long and short facial heights.

• If the patient is long face/high mandibular angle (on lateral cephalometry) and incisal show at rest is less than 4 mm then choose :
  Extrusion of anterior teeth and intrusion of posterior teeth: UPPER and LOWER 
  
  

• If patient is long face/high mandibular angle and the incisal show at rest is 4 mm or more  then choose:
  Extrusion of anterior teeth and Intrusion of posterior teeth:  LOWER ONLY
  
  
• If the patient is NOT  long face/high mandibular angle (on lateral cephalometry) and incisal show at rest is less than 4 mm then choose :
  Extrusion of anterior teeth only: UPPER and LOWER
  
  
• If the patient is NOT  long face/high mandibular angle (on lateral cephalometry) and incisal show at rest is 4 mm or more  then choose :
  Extrusion of anterior teeth only: LOWER ONLY
  
  
  

• Do not try to treat moderate to severe open bite cases ( e.g. 3 mm open bite) if you do not have enough experience.
• Considering IPR of upper and lower anteriors could help to manage open bite cases.

• If the patient is NOT long face/high mandibular angle and the incisal show at rest is more than 4 mm then choose :
  Intrusion of anterior teeth and extrusion of posterior teeth: UPPER and LOWER
  
  
  
• If patient is NOT long face/high mandibular angle and the incisal show at rest is 4 mm or less  then choose :
  Intrusion of anterior teeth and extrusion of posterior teeth:  LOWER ONLY
  
  
  
• If patient is long face/high mandibular angle and the incisal show at rest is more than 4 mm then choose:
  Intrusion of anterior teeth only: UPPER and LOWER
  
  
  
• If patient is long face/high mandibular angle and the incisal show at rest is 4 mm or less then choose:
  Intrusion of anterior teeth only: LOWER ONLY

• In deep bite cases, if you have chosen " Intrusion of anterior teeth and extrusion of posterior teeth "  you need to place bite ramps.
  
  Considering the biomechanic side effects of precision bite ramps and the concept of "over-engineering" that we follow in this program we recomment to choose 
  
   "Place bite ramps on lingual of upper canines
  
• We usually do not need bite ramps in other cases and we choose "none".  

• Midlines could be assesed in clinical exam only.You cannot do it on recods.
  
  
• Upper mildline to face is the most important midline assessment. We use the philtrum as the refrence line. Do not assess the midline of upper teeth to nose tip. Deviation of nose tip is very common.
  
  
• 
  
• If upper midline is off to right and you planned to improve it with IPR, you choose: improve midline with IPR and then in the next section you tick off  improve of upper midline with to patient's left.
  
  
• Please keep in mind that midline discrepancy may have a complex etiology like Bolton discrepancy, occlusal interferences and shift on closure.

• Correction of single tooth crossbite is ususally predictable. However, correction of bilateral or unilateral dental crossbite is not recommended if you do not have enough experience.
  
  
• Trying to correct the dental crossbite could easily lead to buccal crown tipping of posterior teeth and a posterior openbite. In thoses cases if the patient is adult and does not accept a surigal correction we may choos " Do not correct". A faild correction will be a difficult clinical condition to manage.
  
  
• Skeletal crossbite in adult may need more complex treatments like SARPE (Surgically Assisted Palatal Expansion).
  
  
• Unilateral crossbites migh have a complex underlying etiology. In many cases they are moderate(half cusp) crossbite with a mandibular shift on closure. Theses cases should be referred to specialist.

• If the patient has undersized upper laterals, we have to consider leaving space distal to upper lateral(s) for future cosmetic bonding or laminate veneers.
  
  
• The second option in theses cases is IPR of lower anteriors. Clinician ususally overstimate the amount of IPR they do. Furthermore, anchorage loss will not allow us to use IPR to retract the lower anteriors after IPR. It is wise to explain to patient the importance of having teeth with normal size. In addition to aesthetic concerns, an undersized upper lateral can compromize the bite.
  
  
• Overlooking of a Bolton discrepancy and undersized lateral could lead to posterior open bite which is one of the most common side effects of clear aligner therapy.
  
  
• In online version, you have to specify the spaces you want to keep or open up. A pop-up window appears and you can ask Align technician to leave space in between any teeth on a chart.

• Expansion of posterior teeth is almost always needed for resolving the crowding. Over expansion can cause severe buccal tipping of posterior teeth which causes posterior open bite .
  
  
• If the the arch is narrow, V-shaped, Omega shaped you might choosed: Expansion of posterior teeth "Primarily" . otherwise choose : "As needed" .
  
  
• We barely need to tick off "None" .

• Proclination of anterior teeth is desired in patients with retroinclined upper incisors. Class II div 2 cases are the best example. In those cases we choose " Primarily ".
  
  
• In a patient with proclined upper teeth we choose " None ".
  
  
• In other conditions we can choose " As needed ".
  
  
• Common side effects of proclination (expansion of anteiors; aka flaring) includes gum recession and poor lip posture.
  
  
• As a general rule in , IPR of lower anteriors is safer than the upper and proclination of upper anteriors is safer than the lower; Having this rule in mind we can lower the risk of developing a posterior open bite. There is some exceptions though.

• If the overjet is minimum IPR of upper teeth could cause posterior open bite. In this condition choose " None ".
  
  
• If we have a severe overjet and we want to manage that with IPR , we can choose " Primarily "
  
  
• We do not recommend to choose " As needed " if you are not sure. We can do it later on ClinCheck.
  
  
• We have the same considerations for using IPR of the upper anteriors to improve the upper midline. If there is not enought clearance in between upper and lower anteriors , IPR of upper anterior may cause posterior open bite .
  
  
• As a general rule in , IPR of lower anteriors is safer than the upper and proclination of upper anteriors is safer than the lower; Having this rule in mind we can lower the risk of developing a posterior open bite. There is some exceptions though.
  
  As a general rule in , IPR of lower anteriors is safer than the upper and proclination of upper anteriors is safer than the lower; Having this rule in mind we can lower the risk of developing a posterior open bite. There is some exceptions though.

• Generally we do not recommend IPR of posterior teeth. It is clinically difficult to do it with IPR strips/disks and using IPR burs is too aggressive. Carries risk and loose contact points are other among other reasons for avoiding IPR of posterior teeth. 

• Expansion of posterior teeth is almost always needed for resolving the crowding. 
  
  
• If the the arch is narrow, V-shaped, Omega shaped you might choosed: Expansion of posterior teeth "Primarily" . otherwise choose : "As needed" .
  
  
• We barely need to tick off "None" .

• Proclination of lower anterior teeth could lead to posterior open bite if the clearance in between upper and lower anteriors is not enough. 
  
  
• Another key factor is the relationship between deepbite and the amount of proclination. If we do not mange to open the bite enough, proclination of lower anteriors in class I patients can cause heavy anteior bite and posterior open bite. It is a common reason of posteior open bite in clear aligner treatments.
• In class I cases with crowded loweranteiors and minimal overjet, choose  "None" .
  
  
• In class I cases if we have enough overjet; the overbite is normal and we also have considered proclination of the upper anteiors to resolve the crowding, we can choose " As needed" .
• In Class III case choose "None"  . Proclination of lower anteriors causes underbite.
  
  
• In Class II div 1 patients we can choose "Primarily" or "As needed"  to reduce the overjet. The side effect is gum recession. If the attached gingiva is not enough avoid proclination.
  
  As a general rule in , IPR of lower anteriors is safer than the upper and proclination of upper anteriors is safer than the lower; Having this rule in mind we can lower the risk of developing a posterior open bite. There is some exceptions though.

•   You can always choose "As needed" unless there is a contradiction or patient declines IPR.  
  
  
• In Class I patients with minimal overjet and crowding of lower anteriors if we avoid IPR of lower anteriors, treatment may causes a posterior open bite specially if the overbite is more than 20 percent. These cases are very common They could be a "late crowding" or an orthodontic minor relapse.
  
  As a general rule in , IPR of lower anteriors is safer than the upper and proclination of upper anteriors is safer than the lower; Having this rule in mind we can lower the risk of developing a posterior open bite. There is some exceptions though.

Generally we do not recommend IPR of posterior teeth. It is clinically difficult to do it with IPR strips/disks and using IPR burs is too aggressive. Carries risk and loose contact points are other among other reasons for avoiding IPR of posterior teeth. 

• We do not recommend bicuspid extraction to resolve crowding.
  
  
• If the case chosen carefully single extraction (lower incisor) could have predictable results. The best example is undersized upper laterals (Bolton discreppancy) with crowded lower anteriors. If patient declines build-up of upper laterals, single extraction might be indicated.