Studying insurance plans can be a chore. Policies, premiums, deductibles—all those numbers can make your head spin. Hang in there, because the particulars of your insurance plan can play a big role in determining your medical, dental, and even orthodontic expenses. Getting coverage for your orthodontic treatment depends on a few different factors, primarily whether or not your benefits include Teledentistry coverage.
Your insurance could cover around 50% of your byte treatment, and there’s also a chance it won’t cover anything. It all depends on your specific provider and plan. If you’re wading through pages of healthcare jargon trying to decipher your plan, byte can help make the process easier. And this guide will give you an in-depth look at the policies and procedures involved with benefit claims for byte’s at-home orthodontic treatment.
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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 byte. 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. That said, to help more patients utilize their benefits, byte has partnered with Anthem and Guardian as a covered in-network orthodontic service. Plus, they have partnerships with 2 other large dental insurers that will soon be announced.
The moral of the story is that you shouldn’t simply assume that your dental insurance will cover byte, or any orthodontic treatment, for that matter. byte makes it simpler through their partnerships with multiple insurance companies, but you should still familiarize yourself with your plan’s details and work with byte to see if you’re eligible for coverage.
Is byte Covered Differently Than Braces or Invisalign?
Next scenario: you have dental insurance and orthodontic benefits. Will you receive coverage for byte treatment? Surprisingly, not always.
With byte, a certified dentist or orthodontist in your state will approve and supervise your care remotely, rather than in person. Some dental insurers treat byte just like braces or Invisalign and provide coverage accordingly. However, even though byte services strictly follow the ADA’s outlined requirements for Teledentistry, some insurers wrongfully consider byte’s services as “do-it-yourself” treatment and routinely decline to provide coverage.
It’s important to draw a distinction 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 byte is designed and monitored by a licensed dentist or orthodontist, so it doesn’t present the same risks.
Time for the question that’s no doubt on your mind: does my insurance company cover home aligner treatment? Fortunately, byte partners with a few big-name insurance companies. These are the ones with a good track record of supporting them:
- Anthem (which includes Empire and others)
- More coming soon!
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?
Head over to byte’s insurance page and a “Check Coverage” option will be one of the first things you see. Enter your email address and the site will direct you through a series of pages where you’ll provide your insurance plan information. They’ll do all the legwork, checking to see if your plan provides partial coverage for their treatment.
Some online reviewers report situations where a byte representative told them they would receive insurance coverage, but their provider still denied the request. Just like other medical or dental insurance claim processes, the insurer can initially deny the claim for any number of reasons, often ones with easy remedies. If this happens to you, just let byte know. Their insurance team will discuss it with the insurer on your behalf and handle any additional appeal paperwork.
How Do I Claim My Insurance Benefits?
Checking on your coverage is just the first step. And typically, it’s the easiest one too. Filing an insurance claim to receive the coverage is more complicated and time-consuming. But with byte, you won’t have to worry about it. They’ll complete all of your claim paperwork, so you just have to sign and date it.
One common reason insurers will deny a claim is if there’s an error in the paperwork. But because byte’s team of insurance professionals will complete it all, you can rest assured it’ll be correct. This process is particularly streamlined for companies with whom byte already has a partnership (like Anthem, Guardian, and others).
In some cases, byte will accept payment from the insurer directly. For example, if you have 50% coverage from Guardian, you’ll only need to pay half upfront and byte will handle the rest with the insurance provider so you don’t have to.
Companies that don’t have a partnership with byte might still provide coverage, although it may come in the form of reimbursement. You would need to pay full price (or begin a payment plan), and you would receive a check from the company for the percentage they cover. Sometimes this reimbursement is spread throughout the course of your treatment.
What If My Insurance Company Denies My Benefits?
So what happens if byte tells you that you’ll receive coverage, but the company denies your claim? It’s a real possibility and it can be tough to determine the insurer’s reasoning. Fortunately, you won’t have to.
When byte says they’ll handle your entire insurance process, they mean all of it. So, if your claim gets denied, they’ll contact the insurer to find out why then work to correct the issue. And they’ll always side with the patient, keeping your best interests in mind as they help you navigate insurance disputes.
It might be frustrating to hear that your treatment isn’t covered, but before you dial up your insurance provider, reach out to your byte advisor. Their insurance team has seen these situations time and time again, so they know how to handle them. It might be as simple as making plan-requested edits to your initial claim, or it could require an appeal, which is a more intensive process. No matter how complicated, byte will be with you every step of the way.
If you simply aren’t covered, you can look into bytepay, which splits the total cost into more manageable monthly payments. What’s nice is that everyone qualifies, regardless of credit score, although it does have interest, so you’ll end up paying a bit more in the long run.
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 byte treatment. Whether or not you’re eligible for insurance coverage, this can be a great way to help cover the cost of your treatment.
byte accepts payments from FSA and HSA accounts to purchase impression kits, aligner treatment, and aftercare retainers. If your account is linked to a debit card, just use it like you would any other card. Otherwise, reach out and byte will help you get set up. You can use insurance and an FSA or HSA account to pay for treatment if you have both.
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!
Despite what you might have heard, it’s definitely possible to get your at-home aligner treatment covered by insurance. Depending on your specific provider and plan, you might get up to 100% covered! And byte will guide you through every step of the process, even handling tough paperwork, so that you can get the best price possible.