Is SmileDirectClub Covered by Insurance?

You know the drill: present your insurance card, pay your copay, and go about your day. It’s how we handle most of our medical transactions. But orthodontic treatment — especially remote options — is a different ball game. Getting coverage for your SmileDirectClub treatment depends on a few different factors, primarily whether your benefits include teledentistry coverage.

This can play out in different ways, depending on your particular insurance provider and plan. It’s possible that your insurance will cover 50% of your SmileDirectClub treatment. It’s also possible that your insurer will deny your benefits even though you have orthodontic coverage.

That’s why we created this guide. Read on for an in-depth look at the policies and procedures involved with benefit claims for at-home orthodontic treatment with SmileDirectClub.

Does Health Insurance Cover Orthodontics?

The answer to this question is simple: no, health insurance doesn’t cover orthodontics. And it doesn’t matter if you are looking at a traditional option like braces or a remote one, like SmileDirectClub; health insurance excludes dental coverage, and orthodontics falls under that umbrella. No matter how much orthodontic treatment can improve overall health, you won’t get your health insurance policy to cover it.

And if these policies don’t cover traditional orthodontics or preventative dentistry, they won’t pay for remote aligners, which even most dental policies classify as cosmetic treatment. So if you have health insurance without a dental policy, expect to pay for your SmileDirectClub treatment in full.

What If I Have Dental Insurance?

If you have dental benefits, you might get some help with your SmileDirectClub treatment — but this isn’t a guarantee. Dental insurance is meant to cover preventative care (like semi-annual cleanings) and other routine procedures, such as fillings, root canals, etc. Orthodontics is considered extra and requires special coverage that isn’t built into every dental plan. Even when it is, it comes with special considerations.

• Lifetime Coverage Limits: Most policies with orthodontics coverage have a lifetime limit, either per policy or per person. Once you hit that limit, you’re left to pay for treatment on your own. In many cases, this limit is low enough that even when you max out your benefits, you’ll still pay some costs out of pocket.
• Percentage Covered: In many cases, dental policies won’t pay in full for orthodontic treatment, no matter your lifetime or annual limit and whether or not you’ve reached it. Instead, they pay for a specific percentage — usually 50% or less. And coverage gets cut off when you hit that percentage or your limit, whichever comes first.
• Waiting Periods: Many dental policies have a waiting period after enrolling in a plan, meaning you cannot use your benefits until a certain amount of time has elapsed. Typically, the waiting periods are 3–6 months for basic procedures and 6–12 months for major ones. Orthodontic treatment tends to fall into the latter category.
• Age Restrictions: Even if your dental policy includes orthodontic coverage, it might exclude anyone over 19. Since orthodontic treatment is easiest — and thus cheapest — for those with bone growth left to come, insurance companies prefer to stick to covering treatment in children and teens.

To summarize, even if you have dental coverage with orthodontic benefits, don’t assume it will cover SmileDirectClub, or any other orthodontic treatment, for that matter.

Is SmileDirectClub Covered Differently Than Braces or Invisalign?

Next scenario: You have dental insurance and orthodontic coverage and there are no restrictions stopping you from utilizing your teeth straightening benefits. Will you receive coverage for SmileDirectClub treatment? Surprisingly, not always.

SmileDirectClub treatment plans are approved by licensed dentists and orthodontists, and your care is supervised remotely. Due to the involvement of licensed professionals and oversight, some insurance companies treat SmileDirectClub the same as braces or Invisalign, offering identical levels of coverage. Others reduce coverage or exclude it because it can only treat cosmetic issues.

Then there is the issue of in-network vs. out-of-network providers. You can work with both, but out-of-network providers tend to receive less coverage and have higher deductibles. Teledentistry providers are typically classified as out-of-network, and this includes SmileDirectClub.

Finally, some insurance providers simply see at-home aligners as illegitimate orthodontic treatment. While this is changing, the industry is still new enough that some companies remain skeptical of covering at-home treatments over braces or Invisalign.

Will You Insurance Cover SmileDirectClub?

Time for the question that’s no doubt on your mind: Does my insurance cover home aligner treatment? Fortunately, SmileDirectClub partners with a few big-name insurance companies. These are the ones with a good track record of supporting them:

• UnitedHealthCare
• Blue Cross Blue Shield
• Aetna
• MetLife
• Anthem
• Capital
• Empire
• Dominion National

Even if you have a different provider, your treatment might be covered. Keep in mind that this is a rapidly changing situation. Insurers are constantly reviewing treatment options and changing their policies based on new research and data.

How Do I Find Out Whether I Have Coverage?

On their insurance page, SmileDirectClub allows you to enter your insurance plan information. They will inquire with your insurance company and contact you by email or text to let you know whether you’re eligible for coverage.

Some online reviewers report situations where a SmileDirectClub 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 various reasons, often ones with easy remedies. In these cases, however, it appears that the customer had to handle insurance disputes on their own, although SmileDirectClub responded to their complaints on social media and review sites and, we assume, continued the conversation privately.

How Do I Claim My Insurance Benefits?

If SmileDirectClub’s support team determines that you can receive coverage, they will prepare the claim paperwork for you. All you need to do is fill out some personal information and send it to your insurance provider.

The tricky part is that SmileDirectClub won’t provide you with an ADA claim form until there’s a dentist assigned to your case, since the form requires dentist information. However, they won’t assign you a dentist until you’ve paid for their treatment. Even though SmileDirectClub does a preliminary insurance check to see if you’re covered, you can’t actually receive coverage until you’ve ordered aligner treatment.

According to their website, “in most cases, SmileDirectClub will coordinate payment directly with the insurance company so you only pay the balance of what you owe after discounts and insurance coverage is applied to the total cost of your treatment.” However, some companies might provide a reimbursement instead. In this situation, you would pay for the aligners upfront (or sign up for a payment plan) and then receive a reimbursement check from the insurance company. Sometimes this reimbursement comes in one lump sum and other times it’s dispersed throughout your treatment.

What If My Insurance Company Denies My Claim?

Let’s say SmileDirectClub does their preliminary check and determines that your insurance company won’t cover their aligners. Or SmileDirectClub determines you will receive coverage, but your insurance company still denies your claim. Then what?

Both are very real situations for some SmileDirectClub customers. The company is doing its best to forge new partnerships with insurance companies, but customers can still have trouble getting coverage.

First, you’ll want to contact your insurance company. It’s not uncommon for insurers to deny claims even if they typically cover teledentistry. If you made a mistake in your paperwork or the insurance agent didn’t recognize the type of treatment, that’s enough for a denial. By calling them, you can clarify the treatment details and potentially work it out.

Another option is to appeal the insurer’s decision. According to Healthcare.gov, you may 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 SmileDirectClub doesn’t openly offer to help with the process.

If that doesn’t work, you might consider enrolling in SmileDirectClub’s financing plan, SmilePay, to help make your payments more manageable. Or, you can apply for CareCredit, a line of credit with flexible payment plans specifically intended for medical expenses.

What About HSAs and FSAs?

Whether or not your insurance will step in to help pay for SmileDirectClub, if you have a Flexible Spending Account (FSA) or Health Savings Account (HSA), you might be able to use the funds to cover treatment costs. These accounts allow you to save pre-tax income and use those funds for medical expenses.

SmileDirectClub accepts payments from FSA and HSA accounts. If your plan has a specific debit card, just process it like you would any other card. Otherwise, contact their customer support team for assistance.

If you want to use your FSA funds, remember that they expire each year — they don’t roll over like they do with an HSA. Time the start of your SmileDirectClub treatment to use your money before it’s gone.

Final Thoughts

The number one takeaway: Check with your insurance provider before starting treatment because it can knock up to 50% off your treatment cost! But even though some SmileDirectClub customers are eligible for insurance coverage, it depends on your provider and plan.

If you’re unsure and don’t want to start the process with SmileDirectClub just yet, you can always reach out to your insurer directly. Once you’ve got that squared away, you’ll have a better sense of your total SmileDirectClub price and one step closer to beginning your smile journey.