I don’t really understand my plan and whether it will cover Invisalign with my regular Elgin dentist. I saw that they do it there and I would rather stick with them for treatment, but do insurance companies care about that? For what it’s worth, I have MetLife. Any help you can offer would be greatly appreciated.
Every single dental plan is different, though most of them do not distinguish between metal braces or Invisalign. It also shouldn’t matter whether you see a general Elgin dentist or an orthodontist, but, again, you’ll need to defer to your particular plan.
Orthodontic coverage doesn’t really work like the rest of your plan does. Typically, they give you a maximum lifetime allowance for any kind of orthodontic work. This means you’ll likely have between $1,000 and $3,000 to spend towards your care, but they also don’t pay it out at 100%. It’s normal for a company to pay 50% up until you hit that maximum. Some particularly stingy plans will only cover 25%. Most orthodontic procedures will fall under this umbrella, whether it’s impressions, head gear, metal braces, or Invisalign.
However, they do throw in stipulations a lot of the time. For example, your plan may not allow any adult orthodontic coverage or it may have a waiting period before you’re allowed to have orthodontic treatment. MetLife has also historically been bad when it comes to out-of-office claims. If, for instance, you need a cephalometric x-ray and your Elgin dentist doesn’t have the machine, they may not pay for you to have it done at a diagnostic center if there’s no dentist on staff.
This probably seems like an overwhelming amount of information to take in, but the good news is that your Elgin dentist probably has an insurance expert on staff and they can send a preauthorization to your insurance company. By taking this step in advance, the insurance company commits to paying what they say they will in their response to you. So, whether the news is good or bad with your particular plan, you can go forward knowing exactly what you’re getting into.
If you haven’t already had a consultation for Invisalign, that should be your first step. Check with the office and ask them to schedule one, and also ask them to prepare a preauthorization for your insurance company. You could have a hard answer from the insurance company in as little as a couple of weeks.
This blog is sponsored by Elgin dentist, Dr. Steve Sirin.