Understanding Insurance Coverage for Invisalign
Will your insurance company pay out for Invisalign aligners?
For many, this is the vital question that needs to be asked before beginning Invisalign treatment. There is no definite answer here as there are several factors at play, however, many of our patients have successfully paid for their Invisalign treatment at San Diego Smile Pros wholly or partly with funds from their insurance providers.
Insurance That May Cover Invisalign Treatment
There are many different types of insurance that may cover your Invisalign treatment. These include, but are not limited to…
- Employer-sponsored dental insurance
- Individual dental insurance plans
- Health savings accounts (HSA)
- Flexible spending accounts (FSA)
The amount of coverage you will have for Invisalign treatment may vary widely depending on your provider and the specific plan you have enrolled in.
Maximize Your Insurance Benefits to Fund Invisalign
Understanding how to maximize your insurance benefits can significantly reduce your out-of-pocket expenses. Key factors to know about include:
- Annual maximum benefits
- Lifetime orthodontic limits
- Waiting periods
- Age restrictions
- Provider network requirements
Find Out If You’re Covered For Invisalign Treatment
If you’re hoping to claim on your insurance for Invisalign treatment, you’ll first need to find out if your plan covers this type of orthodontic procedure. Follow these steps to verify your eligibility for Invisalign treatment through your insurance policy.
- Contact your insurance provider – Find a number for your insurance provider and give them a call. It’s time to get the ball rolling.
- Request a breakdown of benefits – Ask them to send you a detailed list of your insurance benefits along with all the associated terms and conditions.
- Check that you have orthodontic coverage – Carefully read the documentation to confirm whether or not orthodontic treatment is included in your policy, and then thoroughly check the small print so you understand the details of the included cover.
- Confirm in-network providers – Your insurance company may have a list of providers you need to use for your treatment, in order for your claim to be valid. You will also of course want to undergo your treatment with an experienced and reputable orthodontist such as Invisalign specialist, Dr Matthew Durschlag at San Diego Smile Pros, so if your insurer insists on an in-network provider, get the list and start checking out reviews so you can make an informed choice that works for you.
- Review annual and lifetime maximums – Finally, check that you have not already exceeded any limited annual or lifetime limits, and ensure that any Invisalign treatment would be included in any limits should you decide to claim for your treatment.
Understanding Invisalign Costs and Insurance Limits
There are several factors that contribute to the overall cost of Invisalign treatment:
- The complexity of treatment – a more complicated treatment will have a higher cost.
- Length of treatment – the longer you need to complete your Invisalign treatment, the more it will cost.
- Location – some areas simply have higher-cost orthodontic practices than others. Contact local dentists to get an idea of the costs in your area.
- Practice technology– Updated practices with modern tech enable the orthodontist to provide higher quality care.
- Provider expertise – you may pay more for a highly experienced, board-certified orthodontist specialist versus a general dentist providing care.
- Insurance coverage level
Most insurance plans that cover orthodontic treatment will provide between $1,000 to $3,000 in coverage. While this may not cover all of your Invisalign treatment, it will be a large contribution towards it.
Additional Payment Options for Invisalign Treatment
If you do need to make additional payments, or if you choose to self-fund your Invisalign treatment, there are several payment options available:
- Monthly payment plans
- Healthcare credit cards
- FSA/HSA accounts
- Third-party financing
- Provider payment programs
Choose a dental practice such as San Diego Smile Pros that offers a wide range of flexible payment options, so you can pay for your treatment in the way that is most convenient for you.
Invisalign Insurance Coverage – Your Questions Answered
Will my insurance cover the full cost of Invisalign treatment?
Most dental insurance plans provide partial coverage for Invisalign treatment. Typically, you can expect to receive a contribution that covers 25% to 50% of the total treatment cost. You will be responsible for funding the remaining balance.
Will my insurance company pay out less for Invisalign than for traditional braces?
In many cases, insurance providers offer the same level of coverage whether you opt for Invisalign or traditional braces, so there’s no reason not to choose the additional benefits of Invisalign treatment.
Can I use both FSA and insurance to pay for Invisalign?
Yes, you can combine FSA funds with insurance coverage to maximize your benefits and fund your treatment.
I’m a grown-up – can I still get Invisalign through my insurance?
Different providers offer different levels of cover, but nowadays, many insurance providers offer orthodontic benefits that include adult patients as well as children.
What happens if I change insurance providers while my treatment is ongoing?
It may be that your new insurance provider covers the remaining treatment costs, but it’s important to check the details of your policy. We suggest verifying this before you change plans.
Can I appeal if my insurance provider denies coverage?
Yes, you have a right to appeal. You will need to contact your provider to submit documentation from your orthodontist supporting medical necessity.
Making an Informed Decision – Understanding Your Insurance Policy
Understanding your insurance coverage options helps you make the best decision about Invisalign treatment. Whether you self-fund or claim through your insurance provider, Invisalign is a groundbreaking treatment that gets fantastic results. San Diego residents can depend on Dr. Durschlag from San Diego Smile Pros to deliver the highest-quality orthodontic treatment. Dr. Matthew Durschlag is a board-certified orthodontist with a wealth of experience and a whole host of happy clients with beautiful smiles. His specialist skills ensure the successful treatment of even the most complex conditions, including all types of orthodontics, Invisalign, clear and metal braces, lingual braces, TADs (temporary anchorage devices), fixing open bites, crowding, overbites, surgical cases and more!
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