There are a lot of things insurance covers — checkups, procedures, and 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 AlignerCo treatment depends on a few different factors — primarily whether your benefits include teledentistry coverage.
You’re looking at numerous potential outcomes that depend on your insurance provider and plan. Some AlignerCo customers may receive reimbursements for up to 50% of their cost, while others may not be covered at all. It can be confusing, but we’re here for you. This guide will walk you through the policies and procedures involved with benefit claims for AlignerCo.
Table of Contents
AlignerCo Insurance Coverage: The Basics
Getting coverage for at-home aligners, or teledentistry in general, is complicated. Many dental insurance plans, even ones that include orthodontic benefits, refuse to cover at-home clear aligner treatments — even though they’ll often cover in-office ones like braces or Invisalign.
However, an increasing number of providers are open to providing coverage for teledentistry, and depending on your plan, that may include AlignerCo. To know for sure, review your plan’s details and/or contact your provider. If they will cover your treatment, they’ll typically only pay for a percentage, and you’ll need to file for reimbursement.
Does Health Insurance Cover Orthodontics?
Oral health relates directly to overall health. You might assume that this means health insurance would cover dental and orthodontic treatments — at least in cases where they can affect our health at large. Unfortunately, you’d be wrong.
If you want insurance coverage for your teeth, you need a dental policy. This can be separate from your health insurance or an add-on from the same company. Dental insurance comes with various levels of coverage, and not all will offer orthodontics coverage, something we will get into in just a moment.
What If I Have Dental Insurance?
Dental insurance covers preventative care (like semi-annual cleanings) and other routine procedures (fillings, root canals, etc.). Some dental policies have orthodontic coverage, while others don’t. If your goal is to get coverage for AlignerCo treatment, step number one is verifying that your policy covers orthodontics.
Step number two is verifying that it will cover you for orthodontic treatment. This is because having orthodontic coverage doesn’t guarantee you can utilize it. Below are some issues that might come between you and the treatment you need.
- Lifetime Coverage Limits: Orthodontics coverage is typically subject to lifetime limits, which can be per person or per policy. After you hit that limit, there is no more help with orthodontic procedures from your insurance. Usually, this limit is low enough that you can max out your benefits and still have out-of-pocket expenses for treatment.
- Percentage Covered: Plans usually combine lifetime limits with percentage limits — though some policies just have one or the other. When there is a percentage limit, the company will only pay for a set portion of the treatment cost: usually 50% or less. If you have a lifetime limit and hit it before reaching the percentage limit, that’s when coverage stops.
- Waiting Periods: Most insurance policies, no matter the type, have a waiting period. That means no benefits until a certain amount of time passes. Time frames vary by policy but 3–6 months for basic procedures and 6–12 months for major ones is common. Orthodontics is generally considered a major treatment.
- Age Restrictions: Orthodontic issues affect people of all ages, but many plans restrict coverage to patients 19 and younger. Treatment is easier and cheaper when rendered to those who are still growing, so it’s financially advantageous for insurance providers to only cover it in children and teens.
Basically, if you have dental insurance with orthodontic benefits and you need teeth straightening treatment, you might be covered, but you might not. And even if you are, you could discover that your coverage isn’t as robust as you’d hoped.
Is AlignerCo Covered Differently Than Braces or Invisalign?
Assuming you have dental insurance and orthodontic benefits and none of the above issues apply, will you receive coverage for AlignerCo treatment? Not always.
Some insurance companies treat AlignerCo the same as braces and in-office aligners. Since treatment plans are approved by licensed dentists and orthodontists and the company utilizes remote monitoring, this makes sense. But not all insurance providers see it that way.
Certain insurance companies deny coverage because, like other at-home teeth-straightening products, AlignerCo can only make cosmetic changes. Then there’s the matter of how your company classifies teledentistry services. Many consider them out of network, offering little or no coverage, or requiring higher deductibles.
Finally, some insurance providers just don’t consider remote aligners legitimate treatment. Although this is changing, remote orthodontics is still new enough that insurance providers remain skeptical.
Will Your Insurance Cover AlignerCo?
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.
Providers that have partnerships with an at-home aligner company, however, might be more open to covering remote clear aligner treatment in general (although we can’t say for sure). They include:
- Anthem (Blue Cross Blue Shield)
- Empire (Blue Cross Blue Shield)
- Dominion National
Even if you have a different provider, your treatment might be covered. This is a rapidly changing situation. Insurance companies are always reviewing treatments and reassessing their coverage. It’s possible that your insurer has recently begun covering AlignerCo.
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 re-evaluating 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 must 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 the info you need.
Got your treatment preview and dentist? You’re ready for the claim. First, download the claim form for your insurance provider. Make sure that you understand each section of the form and have all the necessary information on hand. Then fill it out carefully and completely. 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’ll 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 Claim?
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 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 can 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.
What About HSAs and FSAs?
Maybe your insurance policy will cover part of your AlignerCo treatment; maybe it won’t. In either case, if you have an HSA or FSA (or both), you might be able to apply those funds toward your costs. These accounts let you save pre-tax income, then apply that money towards approved medical expenses. You just need to check to see if at-home aligners are approved.
AlignerCo allows you to pay with either an HSA or FSA account if you have one. Just use the card 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 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. 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 be one step closer to beginning your smile journey.
Frequently Asked Questions
Do all insurance companies cover at-home aligners?
While more and more insurance companies extend coverage to at-home aligners every year, there are still quite a few that are either hesitant to or not open to it at all. This issue affects the entire teledentistry industry, but remote aligners are often singled out more than other treatments. We believe that, with time, coverage for these services will become mainstream.
Why are some insurers hesitant to cover online aligners?
Every company will have its own reasons but it usually comes down to the lack of in-person oversight and the increased room for patient error. In-person oversight allows dentists to catch rare complications — which are even more rare with at-home aligners because they don’t make big tooth shifts. That same oversight allows the dentist to notice mistakes the patient is making and get them corrected before they can compromise results.
Are there any insurance companies that partner with AlignerCo?
Not at the moment, but that isn’t the same as there being no insurance companies that will cover AlignerCo treatment. It just means that if yours does, you’ll have to pay first, then get reimbursed.
How do I find out if my company offers coverage?
You’ll need to contact them and ask. If they do offer coverage, ask them to walk you through making a claim. Since even one small error on your paperwork can result in a denial, you want to be extra certain you understand everything you need to do.
What should I do if my insurer doesn’t cover remote aligners?
First, don’t assume that denying coverage to AlignerCo means they won’t cover any remote aligners; they might only work with specific companies. Find out if this is the case. If they truly don’t extend coverage to at-home orthodontics, get clarification on coverage for traditional treatments. Then, see a dentist or two and find out how much it will cost you after insurance. Compare this to the cost of AlignerCo and other companies, factoring in financing options and discounts, then select the treatment that’s right for your orthodontic needs and budget.
How long have at-home aligners existed?
The industry launched in 2014 when SmileDirectClub hit the market. This means there is roughly a decade of data behind at-home aligners.
Are at-home aligners safe?
At-home clear aligner treatment plans are always designed and/or approved by a licensed dentist or orthodontist — as long as you’re buying from a legitimate clear aligner service.
The main concern regarding the safety of fully-remote clear aligner treatment is the lack of face-to-face care. Since you won’t be seeing a dentist in-person during treatment, you won’t receive the same level of support that you’d get with traditional in-office aligners like Invisalign or ClearCorrect. That said, a recent NIH-funded survey found the majority of at-home aligner customers were satisfied with their results, and only 6.6% experienced side effects necessitating a visit to their local dentist.
Read our guide to safe home teeth straightening treatment for more information.
Are there other options that might be covered?
If your insurer says no to AlignerCo, they might say yes to traditional orthodontic treatments like braces and Invisalign. It will depend on if you are eligible for orthodontic coverage or not.
What are reasons adults can be denied orthodontic coverage?
The main reason to deny adults orthodontic coverage is because they’re adults. Treatment tends to be easier, and thus more affordable, when given to those who are still growing. You also might be denied if you’ve exhausted your benefits already or are getting cosmetic treatment.