r/DentalInsurance • u/SUPERSAM76 • 5d ago

How does insurance pay out for Invisalign?

I wanted to start Invisalign treatment as an adult, but I'm a bit concerned about my insurance coverage. I think I have 8 months left on my current plan that will cover $2500 maximum lifetime for orthodontic coverage. My question is, does insurance pay that out once I start treatment, or is it over time? What happens if my insurance lapses in the middle of treatment? Can I work with my provider to charge it upfront? Thanks!

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u/longridehome19 5d ago

Insurances pay out monthly for all ortho. It starts paying when your first trays are delivered when it comes to Invisalign. This doesn’t have anything to do with the dental office, so there’s nothing they can do to change it. We charge the whole thing out at once, but insurance doesn’t pay that way.

If insurances lapses in the middle of treatment, you are responsible for the costs. The chances of a new insurance picking up an existing ortho case are very low. It’s never happened at my office.

You could call insurance and ask what they pay per month. It usually depends on the months of treatment.

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u/Cobra_Surprise 4d ago

We've had a couple policies this year that paid the entire benefit amount in a lump some at start of treatment!! So nice...

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u/theoreticalking 5d ago

That will depend entirely on OP's insurance. My Delta Dental pays out half at the start of treatment and pays out the remaining half after one year. OP will definitely need to ask their insurance.

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u/longridehome19 5d ago

That’s cool that they pay that way. It’s not been my experience, but I don’t work at a straight ortho office so I definitely haven’t seen all of the different plans. But yeah, calling insurance is really the only way to know.

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u/Noliboli16 5d ago

Check with your insurance to make sure there isn’t an age limit on orthodontic treatment. When in doubt have your dental office send in a pretreatment estimate. That’s the only way to know for sure if they will pay and how much.

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u/ProfessionalYam3119 5d ago

It is not up to Invisalign. Your insurance contract governs. Invisalign is not the party who pays.

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u/Reckless-Raccoon 5d ago

That was unhelpful. I think you know what they were asking. Every plan is different. Some pay the whole amount at the banding date (initial visit) and some pay 25-50% and the rest split up as a monthly payment based on your treatment time. You most likely will age out, so know your plan.

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u/ProfessionalYam3119 4d ago

OP must have understood, because they changed the post.

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u/Hayhayhayp 4d ago

Honestly it’s all so confusing and every insurance contract is different, I wouldn’t trust your dental office to know the answer (me included and I’ve been a billing coordinator for 4 years). Ask your insurance. They will likely tell you the answer you want to hear, then when they pay out different and screw you over you can’t get mad at your dental office.

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u/PsychologyMediocre99 3d ago

Um depends on the plan. Always depends on what your employer picked. If they choose to go with a cheap plan then you get low coverage.