Guide To Delta Dental Invisalign Coverage
Updated: Oct 12, 2022
Delta dental is one of the biggest dental insurance providers in the US but does it cover Invisalign and other orthodontic treatments? This will be a guide giving real examples of Invisalign coverage by Delta Dental and what your out of pocket cost could potentially be.
Table of Contents:
How to choose the best Delta Dental Plan for orthodontic coverage
Does Delta Dental cover Invisalign?
Delta Dental does cover Invisalign but it depends on if orthodontic benefits are included in the contract of the insurance plan. You must read the fine print in the insurance contract to make sure that orthodontics and Invisalign are an included benefit. As long as it says that it is a provided benefit, you will have coverage for Invisalign through Delta Dental.
What to watch out for:
There are a couple of clauses in the insurance contract which you should watch out for because they may deny you coverage for Invisalign.
Non-covered service. If there is a clause that says orthodontics is a non-covered service or a non-covered expense, you will not have any coverage for Invisalign.
Limitations and exclusions. There may be a clause where Delta Dental says that there are orthodontic benefits but it is only available for those age 19 or under. This is a limitation and it excludes all insured members over the age of 19 from receiving the orthodontic benefit. Yes, the plan does have an Invisalign benefit but only if you are below a certain age.
To ensure that your Delta Dental plan has coverage for Invisalign, make sure you choose a plan that does NOT have the above two clauses.
Network status of your dentist or orthodontist
Delta Dental can provide coverage for orthodontics regardless of the status of the dentist or orthodontist. The only instance it would make a difference is if there is a clause in the contract, which states "In Network Only". If you have that clause then you must see a provider who is in network because an out of network provider would be a reason for your insurance to deny the claim.
Different types of Delta Dental
There is actually just about a Delta Dental for every state. For example there is a Delta Dental of NY and a Delta Dental of CA. The state that your delta is from is not important, what is important is whether your specific plan has coverage for Invisalign.
Coverage for other types of aligners?
Delta Dental does not make a distinction among the different types of invisible aligners so when they cover Invisalign, they will cover the other types of aligners as well. This is a list of some of the most popular clear aligner systems that are being used in the United States. It is not meant to be comprehensive but just to give you an example.
An EXCEPTION to the clear aligners
Even though Delta Dental will cover most clear aligners, they will not cover the at home or DIY invisible aligners. In fact, SmileDirectClub filed a lawsuit against Delta Dental back in 2020 because Delta was refusing to provide coverage for their DIY aligners. The reasoning was that the products were DIY and not done by a licensed dentist.
Nonetheless, the situation has not changed and Delta Dental currently still does not cover any of the do it yourself clear aligner options such as:
This list is not all inclusive because new brands are being released continuously.
Coverage for braces?
Delta Dental will cover traditional orthodontics or otherwise known as braces. In fact, most of the pre-determination claims that we receive back from Delta Dental do not specifically mention braces or Invisalign. The pre-approvals only say "approved orthodontic treatment" without mentioning what type of orthodontic treatment. The short answer is yes, braces are a covered treatment.
Average cost of orthodontics before insurance
The average cost of Invisalign will be between $4000-$8000 but it depends on the cost of living in your neighborhood. If you live in a low cost of living neighborhood, it would be on the lower end averaging between $4000-$6000. If you live in a high cost of living area, it would cost between $6000-$8000.
Our dental office is located in Long Island City, NY and it is a high cost of living city so the price is between $6-8000. Our LIC dental office is currently charging $6000 for the full comprehensive Invisalign treatment. That fee is actually on the lower end because we know that the orthodontist a couple blocks down is charging well over $8000 for the case.
Of course, these are the fees without any insurance coverage but if you do have coverage for it, it will bring the total cost down.
Example of a real Delta Dental Invisalign claim
This is a real Delta Dental Invisalign insurance claim but with the confidential information blocked out. It will provide enough information for you to understand what the coverage is going to be.
For this claim Delta Dental will cover 50% of orthodontic treatment BUT it is not that simple.
The insurance actually has a ceiling limit or cap on the maximum amount that they would cover and that would be $3805 and they would cover 50% of that. This means that your insurance would provide a benefit of $3805 x 50% = $1902.50
$1902.50 is what your insurance would contribute to the treatment
If you look at the "submitted amount" that is the total fee that your dentist has submitted to the insurance and that is $6898 which is significantly more than what Delta dental is willing to cover.
In this case your out of pocket cost would be the difference of $6898 - $1902.50 = $4995.50
Exceptions: There is one additional thing that you should watch out for because there is an orthodontic benefit maximum. It seems like this particular insurance plan most likely has a $2000 benefit maximum and it is willing to pay out close to the max.
Your plan may have a lower maximum which can be $1000. If you only have $1000 the calculations would be as such $3805 x 50% = $1902.50. That would be what they would consider but since you only have a $1000 benefit maximum, it would drop down to just $1000.
Your total out of pocket cost would be $6898 - $1000 = $5898
Hopefully those calculations make sense!
How to choose the best Delta Dental Plan for orthodontic coverage
Every insurance plan under Delta is different because they all come with different benefit amounts and different exclusion criteria. In order to position yourself for the maximum amount of orthodontic coverage you should choose a plan with these criteria.
Choose a plan that HAS orthodontic benefits.
Ensure that the plan has the highest coverage %; Most plans do 50% coverage but if you can find a higher one you should choose it.
Make sure that there is no exclusion criteria such as an age limitation on the benefit. An example would be orthodontic benefits only for those under age 26.
Choose a plan that has a high maximum for orthodontics. For example if there was a plan that offered $1500 benefit vs a $3000 benefit, you should choose the $3000 one.
As long as you follow the above guidelines, you should be able to decrease your out of pocket expense when using Delta Dental for Invisalign.
How to file a claim
Most dental offices will film the insurance claims on your behalf so you don't have to submit any paperwork. In fact when you first filled out all of your check-in forms on your first visit, all of that information you entered was so that your dentist can submit the claim on your behalf. You don't have to sign anything either, your dentist will file everything electronically.
There is an exception and that is some dental offices may not submit the claim on your behalf. If this is the case, you would have to fill out the claim yourself and submit for reimbursement. You can find a copy of the American Dental Association dental claim form here.
Dental Code to use for submitting for Invisalign
The ADA code that you should use to submit for all orthodontic treatment, including Invisalign is D8090. That code is all inclusive for moving your teeth. There is no additional code that you need to write on the form.
Alternative payment options
Most dental offices will offer multiple payment options for Invisalign. Since it is a high ticket price item, there are usually financing options available. Our dentists in long island city will offer an in house payment plan and also financing through carecredit. The financing options will require a credit check, which typically uses your driver's license number as verification.
Most of these financing options offer long term repayments with zero interest rates. For instance, carecredit often has a plan for Invisalign where you can do 24 months no interest.
Alternatively you can always pay with cash, check, or credit card.
All dental offices will also accept HSA (health savings account) and FSA (flex spending accounts) cards. These cards work similar to a debit card. Most employers will approve all expenses at a dental office and that includes Invisalign.
If you are trying to pay with cryptocurrency, you may need to inquire with your dentist. If they are avant garde, they may accept the coins as a form of payment.