Insurance
YOUR DENTAL INSURANCE COULD HELP OUT
We bill, you get paid!
There's good news for those of you seeking clear aligner therapy who have dental insurance: You might get a significant reimbursement check from your dental insurance company. Clear aligner treatment falls under the scope of orthodontic coverage. If you have orthodontic coverage and meet the criteria, your insurance company might reimburse you for some or all of your treatment costs. Let your clear aligner provider know which insurance you have and they will take care of the billing for you or provide you the necessary forms to fill out.
DEALING WITH DENTAL INSURANCE
How do I get reimbursed for my clear aligner therapy?
Follow the following steps in order to maximize your chances of getting reimbursed for clear aligners from your dental insurance company:
Step 1 - Verify your orthodontic coverage
The first step is to make sure that you have dental insurance with orthodontic benefits. Not all dental insurance plans cover ortho treatment. Some have age cut offs and some have strict rules and regulations where few people ever qualify. Contact your dental insurance carrier to see if they offer orthodontic benefits and see if you meet their criteria.
Step 2 - Send your claim to your insurance company
If your insurance covers orthodontic treatment and you meet their criteria, then it's time to send in your claim. Start your clear aligner treatment with your dentist and ask them to bill your dental insurance. Some dentists give you the forms and you have to fill them our yourself. Once your insurance company receives your claim, they will process it and get back to you. Reimbursement checks vary widely and they can range anywhere from less than 50% all the way to full coverage of your treatment costs.
Step 3 - Follow up with your insurance company as needed
Your insurance company can take up to 30 days to respond to your claim. Be patient, but at the same time be sure to followup with your dental insurance company. The squeaky wheel gets the grease! It's not uncommon for insurance companies to ask for more information. Followup with your dental insurance once a month until they provide you with a satisfactory answer.
Keep in mind, your dentist and your clear aligner manufacturer are not responsible for your insurance claim! We do not work for your insurance company and we can not make a guarantee of payment on their behalf. Each case is handled differently and it's ultimately up to your insurance company to handle your claim. We recommend that you call them once a month to make sure they are prioritizing your claim and following up on it.
BETTER CHANCE OF REIMBURSEMENT
You're more likely to get reimbursed with dentist delivered clear aligner programs
Insurance companies are super smart and find ways to not pay for treatment whenever they can. This is why they routinely reject claims sent by do-it-yourself clear aligner programs like Smile Direct Club™ and Candid Co.™. How can they do this? These claims are rejected because they are considered to be cosmetic and not medically necessary treatment. Basically, your insurance says that straightening your teeth with DIY aligners is the same as bleaching your teeth. Since there is no dentist supervision, there's not much you can do about it either.
In contrast, dentist-delivered clear aligner programs like Invisalign© and Even28 at-dentist™ require direct dentist supervision. Plus, they address your bite issues and fix your underlying orthodontic problem. This means that Invisalign© and Even28 at-dentist™ treatment usually qualifies as medically necessary treatment. Therefore, you have a much higher chance of getting reimbursed by your dental insurance carrier. Find a clear aligner provider near you to learn more about treatments they offer and start fixing your smile today!