Does Insurance Cover Invisalign? How to Use Your Insurance for Invisalign
June 12, 2023
If you’re thinking about getting Invisalign for yourself or a family member, you already know how expensive it can be. That’s why it’s crucial to get your Invisalign covered by insurance, if possible. But when does insurance cover invisalign? And how do you choose the best insurance for Invisalign?
This post will explain the ins and outs of using your insurance for orthodontic care, whether you’re getting Invisalign through a traditional orthodontist or from a private company that specializes in it. It may not be easy, but it’s worth the effort. Getting your Invisalign covered by insurance could save you thousands of dollars!
When is Invisalign covered by insurance?
The coverage for Invisalign by insurance can vary depending on the specific insurance plan and its policies regarding orthodontic treatment. Here are some factors that may determine when Invisalign is covered by insurance:
- Orthodontic coverage: Some insurance plans include orthodontic coverage as part of their dental benefits. This coverage typically applies to traditional braces, but it may also extend to alternative orthodontic treatments like Invisalign. However, coverage for Invisalign may have specific conditions or limitations, such as age restrictions or pre-authorization requirements.
- Medical necessity: Insurance plans often consider orthodontic treatment, including Invisalign, to be covered if it is deemed medically necessary. This typically applies to cases where orthodontic treatment is required to correct significant functional or structural issues with the teeth or jaw. The determination of medical necessity is usually made by the insurance provider based on the evaluation and recommendation of the treating orthodontist.
- Out-of-network coverage: Some insurance plans may offer coverage for Invisalign even if the orthodontist providing the treatment is out-of-network. The coverage may be subject to different terms and reimbursement rates compared to in-network providers, and the patient may be responsible for a larger portion of the costs.
- Supplemental insurance: In some cases, individuals may have supplemental insurance plans that specifically cover orthodontic treatment, including Invisalign. These plans may provide additional coverage or more favorable terms compared to regular dental insurance.
It's important to review your specific insurance policy or contact your insurance provider directly to understand the extent of coverage for Invisalign. They can provide detailed information on your plan's orthodontic coverage, any requirements or restrictions, and the reimbursement process. Additionally, your orthodontist can assist in determining your eligibility for insurance coverage and work with you to explore potential financing options if needed.
Are out-of-network Invisalign providers covered by insurance?
The coverage for out-of-network Invisalign providers by insurance depends on the specific insurance plan and its policies regarding out-of-network providers. Here are some key points to consider:
- In-network vs. out-of-network: Insurance plans typically have a network of preferred providers, including orthodontists, with whom they have negotiated contracts and discounted rates. In the case of Invisalign, this may involve having a network of orthodontists who are authorized Invisalign providers. Choosing an in-network provider often provides greater coverage and cost savings compared to an out-of-network provider.
- Out-of-network coverage: Some insurance plans may offer limited coverage for out-of-network Invisalign providers, but the benefits may be lower than those for in-network providers. This means that you might be responsible for a larger portion of the costs when choosing an out-of-network Invisalign provider.
- Reimbursement process: If your insurance plan provides coverage for out-of-network services, you may need to pay the full amount upfront and then submit a claim for reimbursement. The insurance company will evaluate the claim based on their out-of-network policies and fee schedule, and reimburse you accordingly.
- Higher costs: Visiting an out-of-network Invisalign provider may result in higher out-of-pocket expenses. Insurance plans typically have a predetermined fee schedule for covered services, and out-of-network providers may charge higher fees that exceed the plan's allowance. The patient would be responsible for paying the difference between the allowed amount and the provider's charges.
It's crucial to review the details of your insurance plan to understand its specific provisions regarding out-of-network Invisalign providers. Contacting your insurance provider directly will provide the most accurate information regarding coverage, reimbursement, and any potential additional costs associated with choosing an out-of-network provider. Additionally, consulting with an Invisalign provider and discussing insurance coverage beforehand can help you make informed decisions about your treatment options.
If you decide to see an out-of-network Invisalign, SuperBill for insurance can help! We file out-of-network claims on your behalf, and we follow up with your insurer to make sure you get the best reimbursement possible.
Do Invisalign providers take insurance even when they are not part of any network?
Yes, Invisalign providers can still accept insurance even if they are not part of any network. When an Invisalign provider is out-of-network, it means they do not have a contracted agreement with a specific insurance provider. However, they can still work with patients who have insurance coverage. Here's how it typically works:
- Fee-for-service: When you visit an out-of-network Invisalign provider, they will charge their regular fees for the services provided. These fees may or may not align with the insurance company's fee schedule or allowed amounts.
- Patient responsibility: As the patient, you will be responsible for paying the full amount charged by the out-of-network Invisalign provider. This includes any deductible, co-pays, or coinsurance as determined by your insurance plan.
- Reimbursement process: After paying the Invisalign provider, you can submit a claim to your insurance company for reimbursement. The insurance company will review the claim and determine the eligible amount based on their out-of-network policies and fee schedule.
- Out-of-network benefits: Depending on your insurance plan, out-of-network benefits may be available. The insurance company will typically reimburse you a percentage of the allowed amount for covered services, and you may receive the reimbursement directly.
It's important to note that out-of-network coverage may vary between insurance plans, and the reimbursement amount can be lower than what you would receive for an in-network provider. Additionally, there may be certain limitations or higher out-of-pocket costs associated with choosing an out-of-network Invisalign provider.
Before proceeding with treatment, it's recommended to contact both the Invisalign provider and your insurance provider to understand the financial implications and potential reimbursement for out-of-network Invisalign services. This will help you make an informed decision and plan accordingly.
Does health insurance cover Invisalign differently depending on your plan?
Yes, health insurance coverage for Invisalign can vary depending on your specific health insurance plan. Different insurance plans have different policies and levels of coverage for orthodontic treatment, including Invisalign. Here are some factors that may result in different coverage:
- Orthodontic coverage: Some health insurance plans include orthodontic coverage as part of their dental benefits. This coverage may apply to traditional braces as well as alternative orthodontic treatments like Invisalign. However, the extent of coverage for Invisalign may vary between plans. Some plans may cover Invisalign to the same degree as traditional braces, while others may have specific limitations or require additional documentation for Invisalign treatment.
- Plan type: Different types of health insurance plans, such as HMO, PPO, or EPO, may have varying levels of coverage for orthodontic treatment, including Invisalign. For example, some comprehensive plans may provide more extensive coverage, while basic plans may offer limited coverage or exclude orthodontics altogether.
- Age restrictions: Insurance plans often have age limitations for orthodontic coverage. Some plans may provide coverage for children only, while others may extend coverage to adults as well. The age limit for coverage may impact the eligibility for Invisalign treatment.
- Network restrictions: Insurance plans typically have a network of preferred providers, including orthodontists. In-network providers have negotiated agreements with the insurance company, which can result in better coverage and reduced costs for patients. If your insurance plan has a network, the coverage for Invisalign may differ depending on whether you choose an in-network or out-of-network provider.
- Maximum benefit: Health insurance plans often have a maximum benefit or lifetime limit for orthodontic treatment. This limit indicates the maximum amount that the insurance company will pay toward orthodontic services, including Invisalign. The maximum benefit may vary between plans and impact the coverage for Invisalign treatment.
It's important to review your specific insurance policy or contact your insurance provider directly to understand the details of your coverage for Invisalign. They can provide information on your plan's orthodontic coverage, any requirements or restrictions, and the reimbursement process. Additionally, consulting with an Invisalign provider who accepts your insurance can also help determine the coverage and associated costs for your specific case.
How to get your Invisalign covered by insurance
To increase your chances of getting your Invisalign treatment covered by insurance, you can follow these steps:
- Review your insurance plan: Carefully read your insurance plan documents, including the Summary of Benefits and Coverage, to understand the orthodontic coverage details. Look for any specific information regarding coverage for Invisalign treatment.
- Contact your insurance provider: Reach out to your insurance provider directly to inquire about the coverage for Invisalign. Ask about any requirements, limitations, or pre-authorization procedures associated with orthodontic treatment, including Invisalign.
- Obtain a treatment plan and cost estimate: Schedule a consultation with an Invisalign provider to discuss your orthodontic needs. The provider will assess your case and create a treatment plan. Request a detailed cost estimate for the Invisalign treatment, including any necessary X-rays, scans, or other diagnostic procedures.
- Submit a pre-authorization request: If required by your insurance plan, work with your Invisalign provider to submit a pre-authorization request. This involves providing the treatment plan, cost estimate, and any supporting documentation required by the insurance company to demonstrate medical necessity.
- Follow insurance guidelines: Ensure that you meet all the requirements set by your insurance plan. This may include obtaining referrals, adhering to waiting periods, or using in-network providers if necessary.
- Keep records and documentation: Maintain detailed records of all communication with your insurance provider, including names, dates, and summaries of conversations. Keep copies of all submitted claims, pre-authorization forms, and any other relevant documentation.
- Appeal if necessary: If your insurance provider initially denies coverage for Invisalign, you can consider appealing the decision. Follow the appeals process outlined by your insurance plan, which may involve submitting additional information or supporting documentation from your Invisalign provider.
- Consider financing options: If insurance coverage is limited or not available, discuss financing options with your Invisalign provider. Many providers offer flexible payment plans or financing options that can help make the treatment more affordable.
Remember, each insurance plan is unique, and coverage for Invisalign can vary. It's important to thoroughly understand your specific plan's requirements, limitations, and reimbursement process. Working closely with your Invisalign provider and insurance provider can help you navigate the insurance coverage process and maximize your chances of getting Invisalign treatment covered.
What to do if you can’t afford Invisalign
Invisalign can be quite costly without insurance coverage. If you can't afford Invisalign treatment, there are several options you can consider:
- Orthodontic payment plans: Inquire with your Invisalign provider about flexible payment plans. Many providers offer options to spread out the cost of treatment over an extended period, allowing you to make monthly payments that fit your budget.
- Explore financing options: Look into financing options specifically designed for healthcare expenses. Some providers offer third-party financing with low or no-interest rates. These financing options can help you manage the cost of Invisalign treatment by breaking it down into affordable monthly payments.
- Inquire about discounts or promotions: Ask your Invisalign provider if they offer any discounts or promotional offers that can help reduce the overall cost of treatment. They may have special pricing for specific periods or for patients with financial constraints.
- Seek out dental schools or orthodontic residency programs: Dental schools and orthodontic residency programs often offer lower-cost orthodontic treatments, including Invisalign, as part of their training programs. Treatment may take longer due to the learning process involved, but the fees tend to be more affordable. Contact local dental schools or universities with orthodontic programs to inquire about their services.
- Consider dental insurance or discount plans: If you don't have dental insurance, consider exploring dental insurance plans or dental discount plans. Dental insurance plans that cover orthodontic treatment, including Invisalign, can provide significant savings. Dental discount plans offer discounted rates for dental services, including orthodontics, in exchange for a membership fee.
- Save and budget: If immediate treatment is not feasible, consider creating a savings plan to set aside funds specifically for Invisalign treatment. Create a budget and allocate a portion of your income towards saving for the treatment over time.
- Discuss alternatives with your orthodontist: Talk to your orthodontist about alternative treatment options that may be more affordable. Invisalign may not be the only option available, and they may be able to suggest alternative orthodontic treatments that better fit your budget.
Remember, it's important to have an open and honest conversation with your Invisalign provider about your financial constraints. They may be able to help you find solutions or alternative treatment options that can accommodate your budget.
How SuperBill helps with Invisalign insurance
If you do have out-of-network benefits, or you’re unsure if your insurance covers Invisalign, SuperBill may be able to help! SuperBill verifies your benefits, then files and tracks your out-of-network claims. We will update you on the status of your claim at every interval, and do everything we can to get it reimbursed. We even help with medical bill negotiation!
You can jump through all the hoops to make sure you get your Invisalign covered by insurance, OR you can let SuperBill for insurance handle it all for you. We have worked with countless patients to get them the reimbursement they deserve.