If you’ve been comparing different orthodontic treatments, you know that they aren’t exactly cheap. Moving teeth is an expensive business that leaves most patients looking for assistance. For many dental treatments, insurance can be a huge help, but orthodontia is different. It’s not always covered, especially when the treatment is considered cosmetic. But that doesn’t mean you’re out of luck—your United Concordia dental insurance might provide partial coverage, it just depends on your plan.
Some United Concordia plans cover orthodontic treatments and others don’t. But there are a lot of details to consider, like in-network dentists, the type of treatment, and potential coverage limits. Before committing to treatment, read this guide, which provides some foundational information about United Concordia’s plans, procedures, and orthodontic benefits.
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Average Costs Before Insurance
So, orthodontic treatment is pricey, but you’re probably looking for a specific idea of what you might pay. It’s hard to pin down prices for braces or clear aligners because they depend on things like your condition’s severity, your dentist/orthodontist, your location, and the type of treatment. But we’ve got some averages for you, so you can get a general sense of what to expect.
On average, your Invisalign treatment will cost somewhere between $3,000 and $8,000. That’s a pretty big range, but only because the price is subject to several influencing factors. Your condition severity, treatment length, dentist’s expertise, and even where you live can affect your final price. Read through our true cost of Invisalign guide for a closer look.
Although Invisalign is the original clear aligner producer, they’re no longer the only one. ClearCorrect hit the scene in 2006 and has been a worthy competitor ever since. They charge less for lab fees than Invisalign does, so their prices can be slightly lower, often in the $3,000 – $5,000 range (although up to $8,000 is possible too). Then there’s Six Month Smiles, who offer clear braces and aligners that treat minor cases in, you guessed it, six months. Despite being a shorter treatment, Six Month Smiles often costs $3,500 – $5,000, according to their website.
At-Home Clear Aligners
While Invisalign must be administered in a dentist or orthodontist’s office, at-home aligners let you complete treatment (you guessed it) at home. A remote dentist will design your treatment and you’ll receive all of your aligners in the mail, then follow your treatment plan to gradually shift your teeth.
The appeal of at-home clear aligners is in large part due to their affordability. They’re often thousands cheaper than in-office clear aligner treatments, around $1,500 – $2,500 on average. Unlike Invisalign and ClearCorrect, home aligners come at a flat rate. The only difference is which company you choose. For example, SmileDirectClub is always $1,950 while AlignerCo is $1,145.
Our top-ranked provider is byte, which costs $1,895 for standard treatment and $2,295 for byte At-Night. They don’t have the absolute lowest price on the market, but their average 3-month treatment time is the industry’s fastest and their byte-for-life guarantee are unmatched. Plus, byte will walk you through the entire insurance process, from initial coverage checks to claims and anything else you might need, making it a whole lot easier. Check out our guide on insurance coverage with byte for more info.
The most time-tested orthodontic treatment can also be one of the most expensive. Traditional braces typically fall somewhere in the $4,000 – $6,000 price range, although that price depends on a few factors (see our guide on the true cost of braces). Like Invisalign, the exact amount depends on your condition severity, orthodontist’s rates, and where you live.
It also depends on the type of braces you choose. You have a few options: traditional braces, lingual braces (which sit behind the teeth), clear/ceramic braces, and Six Month Smiles braces. Specialty braces (lingual, clear) often cost more than traditional ones. Lingual braces, for example, can cost up to $10,000.
What Does Dental Insurance Usually Cover?
Insurance companies often classify dental procedures into one of four categories: preventive, basic, major, and cosmetic.
Most plans cover 100% of your preventive treatments like cleanings. They might also completely cover basic treatments like fillings, gum disease treatment, and root canals, or they might provide something like 75% coverage. Major treatments like crowns and bridges are usually covered at a lower rate, sometimes around 50%. Cosmetic procedures, like whitening, veneers, and tooth shaping are rarely covered by dental insurance plans. Of course, the percentages for each category depend on your specific plan.
Notably, clear aligners and braces are sometimes considered a cosmetic form of treatment, and other times they are considered a form of major treatment. Some plans will include orthodontic benefits that can help cover the cost of braces, aligners, or other procedures, while others do not.
Different providers and plans cover different procedures, so you shouldn’t assume that you’ll receive coverage for your treatment just because you have orthodontic benefits. Additionally, sometimes this coverage comes with an age limit or an annual or lifetime limit.
It’s also important to know some insurance terminology to fully understand your plan, like:
- Deductible: The amount you’ll need to pay out of pocket before insurance begins to pick up the tab. If you have a $100 procedure, but your deductible is $500 and you haven’t paid any of it yet, you’ll need to pay for the entire procedure.
- Copay: Short for copayment. A set amount that you’ll pay for certain covered treatments. Copays can vary based on the procedure.
- Coinsurance: The percentage of treatment costs you’ll need to cover after you’ve met your deductible. It also varies based on the procedure.
- In-Network vs Out-of-Network: Dental providers often partner with insurance companies to provide “in-network” coverage. When your dental provider is in-network with your insurance provider, coverage rates are typically higher and your dental provider will handle the insurance paperwork for you. With out-of-network care, coverage rates are often lower, and you may need to request reimbursement from your insurance provider directly.
How to Get Orthodontic Coverage with United Concordia
For United Concordia beneficiaries, orthodontic benefits are included in certain plans. If your plan doesn’t include them, you would need to switch to one that does since they don’t offer these benefits as part of a supplemental add-on. However, you can only switch plans during an open enrollment period, or a special enrollment period that comes from a qualifying life event like:
- Changes in household (marriage, divorce, birth, death)
- Changes in residence
- Loss of health coverage
- Becoming a U.S. citizen
Like many others, you might receive dental benefits through your employer. When providing health and dental insurance, employers select certain plans to sponsor, and yours may or may not have chosen ones with orthodontic benefits. If you would like to receive orthodontic coverage, but your employer doesn’t offer a plan that includes it, you can always reach out to Human Resources to see if they might consider changing or adding plans.
Whether or not you have insurance through your employer, United Concordia offers an individual enrollment in their iDental Discount Program. This is not an insurance plan. Rather, it provides savings on certain treatments, including orthodontia. The iDental website says that you can save 10-50% on this plan, depending on the treatment.
United Concordia Invisalign Coverage
Looking into Invisalign? Some of United Concordia’s plans will cover it, but you have to look carefully at the fine print. If you have one of their Flex or Preferred PPO plans, you probably have some type of orthodontic benefits, often up to 50% coverage. However, sometimes this coverage is restricted to dependents under age 19. According to their fine print: “Adult orthodontics is available as a rider to groups of 51 enrolled or more.” So if you have insurance through your employer, they need to have enough beneficiaries enrolled to cover adult treatment. You should speak with your employer’s Human Resources office to find out the details of your coverage.
If you have one of United Concordia’s Plus PPO plans, you likely won’t have orthodontic benefits included.
As similar in-office treatments, ClearCorrect and Six Month Smiles might also be covered, although you’ll want to check with United Concordia to be sure.
United Concordia Braces Coverage
Like Invisalign, braces are often covered by the orthodontic benefits in some of United Concordia’s Flex and Preferred PPO plans. Their Plus PPO plans don’t typically have the same kind of orthodontic benefits. Remember that just because you see “orthodontic” in your plan’s detail doesn’t mean your treatment will be covered. Depending on what your employer offers, there might be age limits or lifetime limits on your coverage.
Lingual braces and clear braces fall into the same boat since they’re used to treat the same kinds of conditions. Six Month Smiles, however, usually treats milder, cosmetic cases, so they might not be covered. You’ll need to check with United Concordia to find out.
Remember that you’ll need to get treatment from a dentist or orthodontist in United Concordia’s network to receive the full amount for your coverage.
United Concordia At-Home Clear Aligners Coverage
United Concordia doesn’t explicitly state whether or not they will cover at-home aligners. And they don’t currently have any partnerships with at-home aligner companies like byte or SmileDirectClub. This doesn’t necessarily mean that they’ll refuse to cover home aligner treatment, but if they do provide coverage, they’re not open about it.
In some online forums and reviews, home aligner customers have stated that United Concordia insurance didn’t cover their treatment. However, we don’t know the details of their plans, and other plans might provide coverage.
If you have a United Concordia dental plan and you’re interested in at-home aligners, you should check with the aligner company and/or an insurance representative to discuss your plan’s details. byte will handle all of your insurance communication, claims, and paperwork for you. Candid and SmileDirectClub will check on your coverage, but they won’t file claims or handle any continuing communication.
How to File a Claim
For in-office treatments like braces and Invisalign, your dentist or orthodontist’s office will file an insurance claim on your behalf, so you don’t have to worry about any paperwork or other correspondence. They’ll only do this, however, if they are “in-network” with United Concordia. If you choose an out-of-network dentist or orthodontist, you may need to file the claim yourself. If you receive insurance through your employer, their H.R. department may be able to walk you through the process.
Most people have never filed a dental claim on their own before, but if you need to, United Concordia has resources that can help. Their Dental Claims Processing page has instructions and frequently asked questions, and their Dental Claims Forms Library has downloadable claim documents.
Home aligner companies may or may not. byte, for example, will walk you through the entire process. They’ll fill out your claim so that there are no mistakes and they’ll also handle any ongoing communication or appeals with the insurance provider. SmileDirectClub and Candid will also help you check on your coverage and file claims, but they don’t go quite as far as byte.
Other companies leave the insurance process up to you. In these cases, you’ll need to download the correct claim form for your insurance provider and fill it out completely. Contact the home aligner company with any questions because a single mistake on your form can get your claim denied.
After your claim is filed, the insurer will process it in a few weeks, or it could take a couple of months.
Other Options if You’re Not Covered
United Concordia’s orthodontic benefits aren’t something you can add on after the fact. They’re either included in your dental insurance plan or they’re not. If your current plan doesn’t cover orthodontia and you want one that does, you’ll need to make a switch, although you can typically only change plans during open enrollment or if you have a qualifying life event.
United Concordia’s iDental Discount Program can also help reduce the cost of your treatment. Like we mentioned earlier, it’s not an insurance plan, but it can still save you money. If you enroll, you’ll pay an annual fee for access to a network of dentists who offer reduced rates on certain treatments, including orthodontics.
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use either one to pay for your treatment. These accounts deduct money from your income before taxes and lets you use it for qualifying medical and dental expenses. They’re often an option with plans sponsored by employers, and if you have one, you can use its funds to pay for your orthodontic treatment. Even if you received partial coverage from MetLife, you could use an HSA or FSA account to pay the remaining balance.
Otherwise, you can look for other ways to make the price tag more manageable, like financing plans. Dentist and orthodontist offices will usually offer payment plans, as will most at-home aligner companies, although a credit check might be necessary to qualify. Or, you can check out third party options like CareCredit, which provide financing specifically for medical and dental expenses (these plans often require a credit check too).
United Concordia can be a good insurance company for orthodontic coverage, but it depends on the plans your employer offers. And if you’re interested in at-home aligner treatment, you might not have great luck since United Concordia doesn’t have the same relationship with home aligner companies that other insurance providers do. But you might still receive coverage, and United Concordia’s iDental Discount Program can help you find great deals on your treatment.
All this information might seem complicated, but your provider can provide a lot of helpful information on your plan if you reach out. And home aligner companies, specifically byte, will also handle communications with your insurer to help you take advantage of your benefits.