So you’re thinking of getting clear aligners and wondering if your insurance will cover it. Knowing what your plan covers will help you budget and avoid surprises. The good news is that many insurance plans cover Invisalign as part of their orthodontic benefits. But the specifics of coverage vary greatly from plan to plan so you need to check each one.
Most dental insurance plans cover Invisalign the same way they cover regular braces. If your insurance covers orthodontics, it usually covers both clear aligners and metal braces equally. This means you won’t have to pay extra for choosing the less obvious treatment. No matter what procedure you choose to straighten your teeth, your insurance co-pay stays the same.
Most plans have orthodontic coverage that is very different from regular dental insurance. Most of the time regular dental insurance covers preventative care like cleanings and exams at a high percentage if not 100%. Moderate coverage is given to restorative work like fillings. Orthodontic benefits have their own rules and limitations. Knowing this difference will help you understand your coverage better.
The biggest limit on orthodontic coverage is the lifetime maximums. Most plans say how much they’ll pay for orthodontic treatment in your lifetime. Most of the time the maximums are between $1,000 and $3,000 but can be different. Once you use up this lifetime benefit, insurance won’t pay for any more orthodontic work no matter what you need in the future.
We often help patients at Dentistry on the Pines navigate the complicated world of insurance. Before treatment starts our administrative staff will call your insurance company to verify your coverage. This verification gives you the right information about how much your plan will cover and how much you’ll have to pay out of pocket. Knowing this ahead of time helps with good financial planning.
Many insurance plans have age limits that affect orthodontic coverage. Insurance companies used to only cover orthodontic treatment for kids and teens. A lot of policies still only cover people under 18 or 21 years old. Adult orthodontic coverage has grown a lot in the last few years though. More plans now offer benefits to people of all ages since adults can also benefit from having their teeth straightened.
Sometimes waiting periods make it longer before you can get orthodontic benefits. With some new insurance plans you may have to have your coverage for six months or a year before you can get orthodontic benefits. These waiting periods prevent people from buying insurance just for expensive treatments and then cancelling it later. To find out about any waiting periods look at your insurance documentation or call your provider.
Most orthodontic benefits require pre-authorization. Before you start treatment insurance companies want to review your plans and approve coverage. We send your insurance company all the paperwork they need such as diagnostic data and treatment plans. This way you’ll know exactly what coverage you’ll get before you agree to treatment.
Different insurance plans pay for different amounts of orthodontic work. Some plans pay for half of the treatment costs up to a lifetime limit. Some might pay for 60 or 70% of the costs. These percentages have a big impact on how much you’ll have to pay out of pocket. More coverage means less out of pocket costs which means treatment is more affordable.
Our Family Dentistry office works with many insurance companies to help patients in Vaughan. Because we’ve worked with so many different types of plans we know how to get you the most out of the benefits you have. We’ve dealt with a lot of insurance issues so we can help you get through the process quickly.
Different insurance providers have different payment schedules. Some people pay their share up front when treatment starts. Some people spread out their payments over the course of treatment sending checks at regular intervals as treatment goes on. Knowing when your insurance provider will reimburse you helps you plan your own payments better.
When family members have more than one insurance plan coordination of benefits is important. If you have both your personal insurance and your spouse’s insurance these plans may work together to give you better coverage. Primary and secondary insurance work together to pay for more of the costs of treatment. We help families figure out how to get the most out of their different insurance.
Some insurance plans only cover certain things if you are in-network or out-of-network. When you go to an in-network provider dental PPO plans usually pay a higher percentage. But a lot of orthodontic benefits are the same no matter what provider network you are in. Checking to see if your network status affects your specific orthodontic coverage will help you choose the right provider.
Health savings accounts and flexible spending accounts are two more ways to pay for orthodontics. These accounts let you save money before taxes for medical costs like Invisalign. By not having to pay taxes on money spent on treatment these accounts help you save money on your real out-of-pocket costs.
Our General Dentistry treatments often go hand in hand with orthodontic treatment. Before starting Invisalign some patients require extra work done like cleanings or fillings. Knowing how your insurance covers different types of care will help you plan your budget for full care. We make sure all of your treatments work together and you get the most out of your insurance for all of them.
It’s very important to follow the rules for paperwork for insurance claims. To file orthodontic claims insurance companies need certain paperwork, pictures and treatment plans. We take care of all the paperwork and make sure all standards are met. This careful process prevents claims from being denied because they don’t have enough or correct information.
When an insurance company denies coverage that you think applies there are ways to appeal. Sometimes the first denials are because of misunderstandings or lack of information. We help patients with appeals by providing them with more paperwork to back up their request for coverage. Sometimes being persistent will get benefits accepted after they were denied.
When coverage is limited or non-existent other options become important. Our office offers payment plans that let you spread the costs out over realistic monthly amounts. Third-party lenders give you longer terms and lower rates than other lenders. Even if you don’t have full insurance coverage these options make treatment possible.
Knowing what your insurance covers is a big part of planning for treatment. At Dentistry on the Pines we spend time helping our Vaughan patients navigate the insurance maze. Book an appointment to talk about what kind of treatment you need. We’ll check your insurance, explain your benefits and list all of your charges in plain language. This thorough process ensures you know what your out of pocket costs will be before you agree to Invisalign treatment so you can make informed decisions about how to spend your money on your smile.