There are a lot of things that health and dental insurance can cover—checkups, procedures, even prescriptions. But what about orthodontics? That’s where it gets complicated. Dental insurance will cover everything from cleanings to root canals, but teeth-straightening treatment is a different story. Getting coverage for your orthodontic treatment depends on a few different factors, primarily whether or not your benefits include Teledentistry coverage.
You’re looking at numerous potential outcomes, and they depend entirely on your specific insurance provider and plan. Some AlignerCo customers have received reimbursements for up to 50% of their treatment cost, while others aren’t covered at all. It can be a confusing process, but we’re here for you. This guide will walk you through the policies and procedures involved with benefit claims for at-home orthodontic treatment with AlignerCo.
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Does Standard Health Insurance Cover Orthodontics?
In short: no, it doesn’t. And this is normally the case whether you’re considering a traditional orthodontic treatment option like braces, or an at-home option like AlignerCo. Health insurance plans are separate from dental insurance plans, so they’ll usually only cover serious, medically-necessary procedures on the face and jaw. Standard health insurance does not cover routine cleanings, fillings, and orthodontic work.
And if routine dental care isn’t covered, at-home teeth straightening certainly isn’t. They’re often considered a cosmetic treatment, so if you just have standard health insurance, you’ll be stuck with the full bill.
What If I Have Dental Insurance?
Dental insurance can be paired with standard health insurance to cover preventative care (like semiannual cleanings) and other routine procedures (fillings, root canals, etc.).
Sometimes these plans will include orthodontic benefits as well, and that’s where you should focus. Orthodontic benefits often come with a lifetime coverage limit (rather than an annual limit). So, if your teeth require extensive or long-term treatment, you might run out. And there are a few other complications:
- On average, orthodontic benefits could cover 50% of the treatment cost up to your lifetime maximum, and a deductible could also apply.
- Some dental benefits have a waiting period, which means you’ll need to wait for a predetermined amount of time after enrolling with your plan before using them (this could be 3-6 months for minor procedures and 6-12 for major ones).
- Other plans have age restrictions. For example, some only cover orthodontic treatment for dependents up to age 19.
- You should be aware of the distinction between “in-network” and “out-of-network” coverage. Treatment by out-of-network providers can be subject to higher deductibles, and may also be covered at a lower rate. Home-based treatment options, when covered, are Teledentistry services that are usually considered out-of-network.
The moral of the story is that you shouldn’t simply assume that your dental insurance will cover AlignerCo, or any orthodontic treatment, for that matter. Familiarize yourself with your plan’s details and contact your provider to see if you’re eligible for coverage.
Is AlignerCo Covered Differently Than Braces or Invisalign?
Next scenario: you have dental insurance and orthodontic benefits. Will you receive coverage for AlignerCo treatment? Surprisingly, not always.
With AlignerCo, a certified dentist or orthodontist in your state will approve and supervise your care remotely, rather than in person. Some insurers treat AlignerCo just like other orthodontic treatments and provide coverage accordingly. However, because AlignerCo does not involve regular, in-person check-ups, certain insurers consider AlignerCo “do-it-yourself” treatment and routinely decline to provide coverage.
It’s important to distinguish between home aligners and the recent concerning trend of DIY orthodontics. The latter stems from online videos where people attempt to shift their own teeth using rubber bands and other crude materials, and it can be highly detrimental to your teeth. At-home treatment through a provider like AlignerCo is designed and monitored by a licensed dentist or orthodontist, so it doesn’t present the same risks.
So will your insurance company cover AlignerCo treatment? Some home aligner companies (like byte and SmileDirectClub) have partnerships with certain insurers that make them “in-network,” which can streamline the process, but AlignerCo doesn’t. You might still receive reimbursement from your insurer, but AlignerCo and online customer reviews don’t specify which insurance companies will typically provide coverage.
Aetna, Anthem, and UnitedHealthCare have partnerships with other at-home aligner companies, so it seems like they’re more open to covering remote treatment. But we can’t say for sure whether or not they’ll cover AlignerCo.
Even if you have a different provider, your treatment might be covered. Although there are other companies that aren’t as likely to cover at-home aligners.
Note that this is a rapidly changing situation. Many insurers have recently updated or are currently updating their policy on coverage for home-based orthodontic treatment. We will continue to update this list as we learn about these changes.
How Do I Find Out Whether I Have Coverage?
Some aligner companies will do a preliminary check with your insurer for you. Just provide your plan details and they’ll do the legwork. Unfortunately, with AlignerCo, you’re on your own. You will need to contact your insurance company to ask whether or not your plan provides coverage for remote orthodontic treatment.
If so, great! You can proceed with their claim-filing process. If not, you’re out of luck, as AlignerCo doesn’t have any policies for filing appeals or finding supplemental coverage. On occasion, an insurer might initially tell you that they will provide coverage, but then deny your claim later on. Why? It could be anything from a paperwork mistake to a re-evaluation of AlignerCo’s treatment. Just know that a preliminary “yes” doesn’t always equal coverage down the line.
How Do I Claim My Insurance Benefits?
You reach out to your insurance company and, great news, they’ll cover part of your AlignerCo treatment. Since AlignerCo doesn’t work directly with any insurers, this payment will come as a reimbursement. And to receive it, you must complete and submit a claim, which is a bit more time-consuming than simply checking your coverage.
Note that you will need to include information for your supervising dentist on the form, so you’ll need to complete your impression kit and receive a treatment plan before proceeding. When AlignerCo sends you a treatment preview, it will include information about your supervising dentist.
Got your treatment preview and dentist? You’re ready for the claim. First, download the claim form for your insurance provider. Then fill it out completely. When you’re done, check it. Then double-check it. One small mistake is enough for a company to deny your claim. So make sure that you understand each section of the form and have all the necessary information on hand. You may need to seek assistance from AlignerCo or your supervising dentist since claim forms require some technical information about the type of treatment and your condition.
After you submit your claim, you have to play the waiting game. With certain companies or during certain times of the year, it might take a couple of months to process a claim. If your insurer responds that they’ll cover part of your costs, you can proceed with your treatment. Your insurance payment will be a reimbursement rather than a direct deduction, so you’ll have to pay the full price (or get financing), then wait for your reimbursement check.
What If My Insurance Company Denies My Benefits?
Consider this scenario: you chat with your insurance company and they say they’ll partially cover your treatment. But after reviewing your claim, they deny coverage. This happens more often than you might think, so you should be prepared for how to respond.
AlignerCo doesn’t handle any insurance-related paperwork or communications. It’s completely between you and the provider, so you’ll have to navigate any discrepancies and appeals on your own. Your first move should be to contact your insurance company. They may be able to tell you why your claim was denied. If it’s a simple paperwork mistake, you can potentially correct it or submit a new one. However, if it’s just because they don’t cover at-home aligners, you might be out of luck.
As a last resort, you can also file an appeal. According to Healthcare.gov, you have the right to request an internal appeal (a re-review by the insurer) within 180 days or an external appeal (a review by the state) within four months. Appeals, however, are often complicated, and AlignerCo won’t help at all with the process.
If your insurer flat out won’t cover anything, there are still ways to make your AlignerCo treatment more affordable. They offer two different payment plans—SmileFlex and SmileFlex Easy—that will break your final cost into manageable monthly payments.
If you believe you’re eligible for orthodontic coverage, but feel overwhelmed by the process of claiming benefits, you may wish to consider one of AlignerCo’s competitors – byte. In our opinion, byte has the most supportive, knowledgeable, and genuinely helpful insurance experts in the industry. Plus, they handle all of the paperwork for you!
What About HSA and FSA?
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) both allow you to contribute pretax income to your medical expenses. They’re an option for many employer health plans (HSAs require a higher-deductible plan, though), and they’re also a viable payment option for your AlignerCo treatment. Whether or not you’re eligible for insurance coverage, this can be a great way to help cover the cost of your treatment.
AlignerCo allows you to pay with either an HSA or FSA account if you have one. Just use the car linked to the account like you would any other credit or debit card. If you don’t have a linked debit card, contact AlignerCo for assistance.
If you have an FSA, remember that they have a time limit, since you can’t roll over funds from year to year like you can with an HSA. Make sure to use your funds before they expire!
Remember: it’s possible to get insurance coverage for your at-home aligner treatment. Even though AlignerCo doesn’t help you through the process, you can still get reimbursed for up to half of your final price. Although it depends entirely on your specific provider and plan, so get in touch with your insurer right away if you’re considering AlignerCo. Once you’ve got your insurance details squared away, you’ll have a better sense of your total AlignerCo price and one step closer to beginning your smile journey.