Metlife Dental is a major dental insurance carrier in the US and they do in fact cover not only Invisalign but also other orthodontic treatments. This is a guide giving a real example of Invisalign coverage by Metlife to prove that they do cover the treatment and what your potential costs could be.
Table of Contents:
Does Metlife Dental cover Invisalign?
Metlife does cover Invisalign but it depends on if orthodontic benefits are included in the contract of your insurance plan. You must read the fine print in the insurance contract to make sure that Invisalign is an included benefit. As long as it says that it is, you will most likely have coverage for not only Invisalign but other orthodontic treatment as well.
What to watch out for:
There are a couple of clauses in the insurance contract which you should look out for because they may potentially 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. You can try arguing with the insurance representative for days and you'll get no where.
Limitations and exclusions. There may be a clause where Metlife says that there are orthodontic benefits but there is an age limitation. If you exceed the stated age limit then you will not have any coverage. Usually these age restrictions are limited to approving dependents and children only.
To ensure that your insurance plan has coverage for Invisalign, make sure you choose a plan that does NOT have the above two clauses. If you are unsure, you should verify with the insurance verbally before making a decision.
Network status of your dentist or orthodontist
Metlife Dental can provide coverage for orthodontics regardless of the status of the dentist or orthodontist. This means that it does not matter if the provider is "in network" or "out of network". You will have coverage no matter which dentist you see.
The only exception is if there is a clause in the contract, which states "In Network Only". If you have that clause then you must see a dentist who is in network because an out of network one would be a reason for your insurance to deny the claim.
Coverage for other types of aligners?
Metlife Dental typically 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.
Coverage for DIY aligners
Here is a list of some DIY aligners, which is not all inclusive since there are new companies coming onto the market continuously:
For these aligners, there won't be a dentist guiding you along treatment. It will be up to you to consult the company and determine what you should do.
Coverage for braces?
Metlife will cover traditional orthodontics because the pre-determination claims that we receive back from them do not specifically mention braces or Invisalign. The pre-approvals only say "approved for orthodontic treatment" without mentioning what type of orthodontic treatment. Therefore the short answer is yes, braces are a covered treatment along with all aligners.
Average cost of orthodontics before insurance
The average cost of Invisalign runs between $4000-$8000 but it depends on the cost of living of where your dentist is located. If you go to a dentist in a low cost of living neighborhood, it would be on the lower end averaging between $4000-$6000. If you see a dentist in a high cost of living area, it would be on the higher end, costing between $6000-$8000.
These are the fees without any insurance coverage so that is what you can expect to pay. However if you do have insurance, it can bring down the costs pretty significantly.
Example of a Metlife Dental Invisalign claim
This is a real Metlife Dental Invisalign insurance claim but with the confidential information blocked out. It is basically approving treatment and giving you an estimate of how much it would cost out of pocket.
For this claim Metlife 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 $4700 and they would cover 50% of that. This means that your insurance would provide a benefit of $4700 x 50% = $2350 but since they have a maximum benefit of $1500, it won't fully cover that.
$1500 is what your insurance would cover since that is the MAXIMUM benefit.
In this case your out of pocket cost would be the difference of $4700 - $1500 = $3200
However you should be aware that there may be additional fees that are not included such as the permanent retainers at the end of treatment. There may be consultation, x-rays, exam, and other procedures which are not included. These all increase the total out of pocket cost.
Exceptions: There is one additional thing that you should watch out for and that is an orthodontic benefit maximum. It seems like this particular plan has a $1500 benefit maximum and that is what they will contribute.
Your plan may have a lower maximum which can be $1000. If you only have $1000 the calculations would be as such $4700 x 50% = $2350. That would be what they would consider but since you only have a $1000 benefit maximum, it would only contribute $1000 towards your total treatment
Your total out of pocket cost would be $4700 - $1000 = $3600
How to choose the best Metlife Plan for orthodontic coverage
Every Metlife insurance plan is different because they all come with different benefit amounts and exclusion criteria. In order to position yourself for the maximum amount of orthodontic coverage, here are some criteria that you should look for:
Choose a plan that HAS orthodontic benefits.
Pick the plan with the highest orthodontic coverage percentage.
Make sure that there is no exclusion criteria such as an age limitation on the benefit.
Choose a plan that has a high maximum benefit for orthodontics. For example if there was a plan that offered $1000 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 by maximizing the amount your insurance will cover.
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 on your own. 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. However, if you did not give all of your information, you would be responsible for filing your own claims.
Please be aware that dental offices filing claims on your behalf is a courtesy. That means that there are some dental offices that may not submit the claim on your behalf. If this is the case, you would have to fill out the claim yourself to get reimbursement sent directly to you. You can find a copy of the American Dental Association dental claim form here.
Dental Code to use for submitting for Invisalign
The ADA insurance code that you should use to submit for all orthodontic treatment such as Invisalign is D8090. That is the only code you need to include on your insurance claim form.
Alternative payment options
Most dental offices will offer multiple payment options for Invisalign in order to help you get the treatment that you want. There are multiple financing options but they all require a credit check, which typically uses your driver's license number as verification. This means that if you have good credit, you will most likely get approved but if you do not, then you will need to find an alternative option.
Here is a list of some common dental financing companies:
Most of these financing options offer long term repayments with an interest rate of ZERO. This means that whatever the cost of treatment is, will be exactly what you will pay. You won't have to pay additional monies for the interest to be on these payment plans. It is a very good offer and if you are able to take advantage of it, you should do it! This is especially true if you get a 24 month no interest payment plan.
Alternatively you can always pay with cash, check, or credit card.
VISA
Mastercard
Amex
Debit
All dental offices will accept HSA (health savings account) and FSA (flex spending accounts) cards. They both work similar to a debit card and that is what it is classified as when processing payment. We haven't seen any HSA or FSA claims get rejected for using it on Invisalign.
There is a possibility that some dental offices may accept cryptocurrency but ours do not.
Takeaway
If you were still wondering if Metlife covers Invisalign, the answer is YES but it depends on the plan that you chose and whether or not it has orthodontic coverage to begin with. If it does then you can expect to pay less than the total out of pocket cost.
The amount of insurance contribution and coverage will depend on the specifics within your plan. That is why it is important to read the fine print closely to make sure that you are eligible under the plan rules.
Author: Written by Dr David Chen, a cosmetic dentist in long island city.
