Invisalign has become a popular choice for orthodontic treatment due to its discreet and comfortable design. However, many dental patients are concerned about whether their insurance will cover the cost of Invisalign. This article provides a comprehensive guide to Delta Dental’s coverage for Invisalign, helping you understand your benefits and make informed decisions about your orthodontic care.
Understanding Delta Dental Insurance
Overview of Delta Dental
Delta Dental is one of the largest dental insurance providers in the United States, offering a variety of plans to meet the diverse needs of its members. With a vast network of dentists and orthodontists, Delta Dental aims to make dental care accessible and affordable.
Types of Delta Dental Plans
Delta Dental offers several types of plans, including:
- Delta Dental PPO: Preferred Provider Organization plans that offer flexibility in choosing dentists within and outside the network.
- DeltaCare USA: A Dental Health Maintenance Organization (DHMO) plan that requires members to choose a primary care dentist and get referrals for specialist care.
- Delta Dental Premier: A fee-for-service plan that provides the broadest access to dentists.
Invisalign: A Modern Orthodontic Solution
What is Invisalign?
Invisalign is a brand of clear aligners used to straighten teeth and correct bite issues. These aligners are custom-made for each patient and are virtually invisible, making them a popular choice for both teens and adults.
Benefits of Invisalign
- Aesthetics: Clear aligners are less noticeable than metal braces.
- Comfort: Made from smooth plastic, Invisalign aligners are more comfortable and less likely to irritate the gums and cheeks.
- Convenience: Aligners can be removed for eating, drinking, and oral hygiene, making them more convenient than traditional braces.
Delta Dental Coverage for Invisalign
General Coverage Information
Delta Dental does cover Invisalign, but the extent of coverage depends on the specific plan and whether it includes orthodontic benefits. Typically, Delta Dental PPO plans offer some level of coverage for Invisalign, while DeltaCare USA plans may not cover it at all.
Criteria for Coverage
To qualify for coverage, the following criteria are generally considered:
- Medical Necessity: Coverage may be provided if Invisalign is deemed medically necessary. This often requires documentation from your orthodontist.
- Comprehensive Orthodontic Treatment: Invisalign must be part of a comprehensive orthodontic treatment plan.
- Specific Plan Details: Each Delta Dental plan has its own guidelines and levels of coverage for Invisalign. It’s crucial to review your plan’s specifics to understand your benefits.
Plan-Specific Details
- Delta Dental PPO: Typically covers 50% of the cost of Invisalign, with an annual maximum payout of around $2,000.
- DeltaCare USA: Generally does not cover Invisalign treatment.
- Delta Dental Premier: Offers coverage similar to PPO plans but with different network considerations.
Factors Affecting Coverage
Age Restrictions
Some Delta Dental plans have age restrictions for orthodontic benefits, covering only those under 19 years of age. It’s essential to check your plan for any such limitations.
Medical Necessity
Invisalign coverage may require proof of medical necessity, such as severe malocclusion or other dental issues that impact overall health.
Network Status of Providers
Coverage can also depend on whether your orthodontist is within the Delta Dental network. Out-of-network providers may result in higher out-of-pocket costs or no coverage at all.
Cost and Payment Options
Average Cost of Invisalign
The cost of Invisalign typically ranges from $4,000 to $8,000, depending on the complexity of the case and the duration of treatment.
Out-of-Pocket Costs
Even with insurance coverage, patients may still have significant out-of-pocket costs. Delta Dental plans often cover 50% of the treatment cost, leaving the patient responsible for the remaining amount.
Payment Plans and FSAs/HSAs
Many orthodontists offer payment plans to make Invisalign more affordable. Additionally, patients can use Flexible Spending Accounts (FSAs) or Health Savings Accounts (HSAs) to pay for treatment with pre-tax dollars.
Alternatives to Invisalign
Other Clear Aligners
Delta Dental generally does not distinguish between different brands of clear aligners. If your plan covers Invisalign, it will likely cover other brands like ClearCorrect and SureSmile.
Traditional Braces
Traditional metal braces are usually covered under Delta Dental plans. They are often less expensive than Invisalign and may be a viable alternative for those seeking orthodontic treatment.
Steps to Verify Your Coverage
Reviewing Your Policy
Start by reviewing your Delta Dental policy to understand the specifics of your coverage. Look for details on orthodontic benefits, age restrictions, and network requirements.
Contacting Delta Dental
Reach out to Delta Dental’s customer service for personalized information about your coverage. They can provide details on what is covered and any out-of-pocket costs you may incur.
Pre-Treatment Estimates
Ask your orthodontist to submit a pre-treatment estimate to Delta Dental. This will give you a clear picture of how much your insurance will cover and what your financial responsibility will be.
Appealing a Coverage Decision
Understanding the Appeals Process
If your coverage for Invisalign is denied, you have the right to appeal the decision. Understanding the reasons for denial is the first step in the appeals process.
Collecting Necessary Documentation
Gather all relevant documentation, including medical records and letters from your orthodontist, to support your appeal. This evidence can help make a strong case for why Invisalign should be covered.
Submitting an Appeal
Write a formal appeal letter to Delta Dental, clearly stating your case and including all supporting documentation. Follow up with Delta Dental to ensure your appeal is being reviewed.
Conclusion
Navigating the complexities of dental insurance can be challenging, especially when it comes to orthodontic treatments like Invisalign. While Delta Dental does offer coverage for Invisalign under certain plans, it’s crucial to understand the specifics of your policy. By reviewing your plan details, contacting Delta Dental for clarification, and considering alternative payment options, you can make an informed decision about your orthodontic care. Remember, a confident smile is an investment in your overall health and well-being.
Yes, Delta Dental plans often include coverage for Invisalign as a standard benefit if adult orthodontic coverage is part of the plan. Coverage levels and eligibility can vary, so it’s important to check the specifics of your plan.
Delta Dental typically covers around 50% of the cost for Invisalign, subject to plan specifics and maximum benefit limits. Some plans may have a maximum annual payout, which can affect the total coverage amount.
Some Delta Dental plans may limit orthodontic benefits, including Invisalign, to members who are 19 years of age or younger. However, this varies by plan, and some do not have an age limit.
Yes, coverage for Invisalign with Delta Dental can vary depending on the plan and state. Different plans have different levels of coverage, and some states may have specific regulations affecting coverage.
To determine if your Delta Dental plan covers Invisalign, review your plan’s Summary of Dental Benefits or contact Delta Dental customer service. You can also consult with your orthodontist, who can provide a pre-determination of benefits.
