Does insurance pay for Invisalign?

Does insurance pay for Invisalign?

If you have dental insurance and questions about Invisalign – we have answers! Many dental insurance plans do cover a portion of orthodontic treatment. However, we generally see plans that do cover Invisalign (through orthodontic benefits) through employer-sponsored plans. The reality is we very rarely see an individually purchased plan with these benefits. Insurance plans that provide orthodontic treatment benefits qualify based on the clinical treatment – and not specifically on the treatment method. In this case, teeth straightening is the treatment, and Invisalign is the method used.

There are also some common criteria that your plan may consider before it provides any Invisalign coverage:

• Age (some plans only consider dependents and/or policyholders under a certain age as eligible)

• Waiting Period (some new plans require a minimum enrollment period, such as 6 or 12 months)

• Review of Medical Necessity (plan determination of the degree or classification of treatment)

With the above information, you should be able to look at your insurance benefits and get a good idea of whether your plan could cover your Invisalign treatment. Additionally, you could ask your benefits manager (if an employer provides your plan) or call the insurance company directly. However, the best way to know for sure is to ask us to send a pre-estimate request to your insurance company. We typically offer to do this during our complimentary Invisalign consultation appointments. The pre-estimate typically comes back from insurance in 1-3 weeks, and usually, a copy is provided to you (or the policyholder) and us to keep everyone on the same page.

What if my insurance ends during Invisalign treatment?

 Some offices ask that you pay the entire treatment price out of pocket and be reimbursed by your insurance. However, as a courtesy to our patients, we help you send dental claims and only collect payment for your portion of the price. This means that insurance will pay us during your treatment, typically monthly or quarterly. Therefore, if your insurance becomes inactive during your treatment, insurance can stop payments – some instances where this has occurred are:

• An employer switches insurance companies, and policies become inactive or change benefits

• An employee switches companies (quit/relocate / transfer) and thus ends their active coverage

• An employee is laid off, and dental insurance is no longer active

• A patient “ages out” of eligibility and no longer qualifies for benefits

In these situations, the patient is responsible for covering the remaining charges the insurance company plans to pay.

How can I find out if my dental insurance will cover Invisalign?

If you have access to your plan's benefits – whether before selecting a plan (typically during the annual Open Enrollment period), starting a new job, or documentation of your current plan – you can look for the section addressing "orthodontic benefits." In particular, you will want to look for the total maximum and the percentage of the overall cost they will cover. For example, a common amount would be 50% of the cost up to $2000 once in a lifetime of the plan.

Once you have found the stated benefit, you will want to consider any restrictions, such as the age or eligibility of dependents. If you need help with this, the best source of information is to call your insurance company directly. However, we are always happy to help and check your insurance.

Finally, before starting any Invisalign treatment, we recommend sending in a pre-treatment estimate request. We do this as part of our standard Invisalign consultation to help you confirm those benefits. Once your insurance has completed the pre-estimate, a copy of the determination is sent to your Winter Park dental office and the plan subscriber.

What if my Invisalign treatment is not medically necessary?

With orthodontic treatment such as Invisalign, it can be difficult to draw a definitive line as to the nature of the treatment necessity. Sometimes, it can be very clear cut, but there are often clinical and cosmetic benefits. Ultimately, your choice to pursue Invisalign treatment is a personal one that clinical or cosmetic goals can drive. Your Winter Park dentist can help you objectively determine what clinical conditions will be treated when teeth are straightened. Most of our patients with the primary goal of cosmetic straightening also find themselves with a bite orientation that is more comfortable after treatment and minimizes premature wear on teeth.

If your insurance requires a detailed assessment of clinical necessity, we are prepared to help you submit this information. Typically, a full set of information required for your insurance (if they request it) will include a dentist's narrative, panoramic x-ray, intraoral photos and other imaging, and specific orthodontic measurements captured via a 3D scan. We have experience gathering and submitting this information to insurance companies and would happily help.

Ready to get started with Invisalign? Have more questions? Please book an appointment with us now!