Medicaid / Tenncare

ATTENTION: On January 2, 2024, Tennessee Orthodontic Studios will pause scheduling initial orthodontic examinations to submit for preauthorization for patients in the Tenncare network. We will honor those patients who are currently scheduled for initial examinations and submit their cases to Tenncare for evaluation. We will gladly treat those patients who are approved for orthodontic treatment. As it stands, we have initial orthodontic examinations for patients in the Tenncare network scheduled as far out as June. We will see all those patients currently scheduled for initial orthodontic evaluations. However, we will not schedule any additional initial orthodontic examinations for patients in the Tenncare network.

How much is a consult/evaluation?

There is no charge unless you have a co-pay.

What should I bring to my appointments?

Bring your Current TennCare card to every appointment

Are there cancellation or late policies?

If you fail to show up for appointments or have a consistent pattern of tardiness you will be referred to another office. If you are late we may reschedule your appointment. Please call if you have to be late.

Does TennCare pay for braces?

If approved, TennCare will pay for your full treatment.

How does the braces process work?

Schedule an evaluation and our office will submit the necessary information to Tenncare. TennCare will then either approve or deny treatment.

How long does it take to hear back from TennCare for approval of braces?

The approval process tends to take around 2-4 weeks after the reauthorization is filed.  You should receive a notice around the same time our practices, but we will contact regardless of you being approved or denied for orthodontic treatment.

What do I do if I am approved by TennCare for braces?

Call our office to schedule a follow-up appointment after receiving an approval letter.

What do I do if I am denied?

If denied, you have three options:

  1. Submit an appeal (see below).
  2. Wait 12 months to submit again with TennCare.
  3. Contact our office to discuss our interest-free financing options.

How do I submit an appeal?

Follow the instructions in your denial letter and submit the appeal form.

  • Appeal by phone: 1-800-878-3192
  • Appeal by mail: TennCare Member Medical Appeals, P.O. Box 000593, Nashville, TN 37202-0593
  • Appeal by fax: 1-888-345-5575

Appeals must be filed within 60 days of receipt of the denial from DentaQuest.

Why did I receive both an approval and a denial letter for braces?

When treatment is denied, TennCare usually sends TWO letters to you. One letter will say that the patient is DENIED for braces, and the other will say the patient is APPROVED for the orthodontic evaluation which already occurred.

Why doesn’t the doctor help with the appeal process?

It does not improve the appeal process.

Will TennCare pay for replacement retainers?

No, they will not. A set of retainers is included in the full treatment fee, TennCare will not pay more than that.

What happens if I lose my TennCare coverage?

If you lose coverage while in treatment, you will be responsible for the remaining contracted price.

Why is there a waiting list?

There are very few orthodontists participating with TennCare.

Why aren’t we seeing patients under 12 for braces?

Due to many factors and the approval process limitations, we chose this age range.

What if my dentist referred me and I need to get in ASAP?

We appreciate the urgency, however, there is an extremely limited number of orthodontists participating with TennCare.