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 at-home clear aligners depends on a few different factors, primarily whether 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. 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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If you decide Byte is the right treatment option for you, be sure to take advantage of this special promotion. Byte is currently offering its impression kit for just $17.95 ($80 off its list price). In addition, as part of this offer Byte will include with your impression kit a free whitening pen to help you brighten your teeth on the go. Enter the code SMILEBRYTE at checkout to claim this promotion.Plus, this special discount can be used in combination with your insurance benefits for even greater savings!
Does Health Insurance Cover Orthodontics?
Without an adjoining dental plan, no, it doesn’t. And this is 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 despite the positive impact they can have on your general health.
And if routine dental care isn’t covered, at-home aligners certainly aren’t. They’re often considered a cosmetic treatment, so if you only have health coverage — no dental — you’ll be stuck with the full bill.
What If I Have Dental Insurance?
Dental insurance covers preventative care (like semi-annual 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.
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?
Let’s assume you have dental insurance and orthodontic benefits and aren’t excluded due to age or a waiting period. Will you receive coverage for Byte treatment? Surprisingly, not always.
With Byte, a licensed dentist or orthodontist will review and approve your care remotely, rather than in person. Some dental insurers treat Byte just like braces or Invisalign and provide coverage accordingly. However, despite Byte services strictly following the ADA’s guidelines for teledentistry, some insurers consider Byte’s services as “do-it-yourself” treatment and decline to provide coverage.
It’s important to draw a distinction between at-home clear aligners and the 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, or 3D print their own aligners based on bootleg software, and it can be highly detrimental to your teeth. At-home treatment through a provider like Byte is designed by a licensed dentist or orthodontist, so it doesn’t present the same risks.
Does Insurance Cover At-Home Clear Aligners?
Sometimes, but the better question is: does your insurance cover at-home aligners? 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 classified as teledentistry services and usually considered out-of-network.
That said, to help more patients utilize their benefits, Byte has partnerships with several companies which make them an in-network provider, including:
If you have a different provider, your treatment still might be covered. 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.
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.
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 more in the long run.
What About HSAs and FSAs?
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 high-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 these funds have a time limit, since you can’t roll over your balance 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 a significant portion of your treatment 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.
Frequently Asked Questions
Do all insurance companies cover at-home aligners?
No. More and more open up coverage to remote aligners every year, but there are still companies that resist covering them, and even teledentistry procedures in general. If you know you want at-home treatment and are currently looking for a dental policy, screen providers based on their openness to covering at-home aligners.
Why are some insurers hesitant to cover online aligners?
Each insurer has their own reasons for including or excluding online aligners from coverage. In many cases, it comes down to the lack of direct and in-person supervision. When you aren’t being closely monitored in person by a dental professional, there is more room for patient error and a greater likelihood for invisible problems to develop unchecked. Patient error is a very real issue — one that you can prevent by following directions carefully. Those invisible problems (such as root resorption) you have no control over and cannot monitor, but they also aren’t particularly common.
Which insurance companies have Byte partnerships?
They currently have direct partnerships with Aetna, Humana, Guardian, Anthem, and Empire (Blue Cross Blue Shield). They are also happy to work with other providers; they just don’t have established partnerships with them yet.
How do I find out if my company offers coverage?
Head to Byte’s insurance page. There, you can enter your email for a free coverage check. Otherwise, there should be a number on the back of your insurance card. Call this number and ask to clarify your benefits regarding Byte (or any other at-home aligner company you are considering).
What should I do if my insurer doesn’t cover remote aligners?
First, verify that they don’t cover any remote aligners. In some cases, they will exclude coverage for certain companies while offering it for others. If they don’t cover any remote aligners, find out if they cover traditional aligners, and if so, the limits on this coverage. Then, see a dentist or orthodontist to get a quote for treatment. Compare the cost of traditional treatment with insurance benefits to the cost of remote treatment without them. Be sure to look at things like financing as well so you understand how each will fit into your budget.
How long have at-home aligners existed?
SmileDirectClub launched their at-home aligners in 2014, effectively creating the industry. This means they have been in use for roughly a decade.
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?
Yes, if your insurance provider isn’t open to covering at-home aligners, they might consider extending coverage for braces and in-office aligners. Some might also work with hybrid companies, like Candid.
What are some of the reasons adults can be denied orthodontic coverage?
Sometimes, it is just a matter of age. Not all insurance policies offer orthodontic coverage to people over the age of 19. You can also be denied if your concerns are cosmetic rather than dental in nature and if you’ve already exhausted your lifetime benefits.