Is Invisalign covered by dental insurance?

Did you know that orthodontic treatments, including braces and removal aids, are the most commonly claimed medical procedures among private health insurance companies (based on information from the Australian Private Health Insurance Ombudsman)? This should ensure that your invisalign treatment can be covered by your dental insurance. Please note that such coverage is only available in private health insurance.

How to claim your Invisalign treatment

The fact that invisalign is a form of removable braces means that it would be classified as an orthodontic treatment. In this case, the Australian Private Health Insurance Ombudsman (PHIO) provides a helpful guide to help you claim this treatment.

The PHIO recommends that you request a written treatment plan from your orthodontist in advance. Various health insurance funds must first determine your orthodontics reimbursement on the basis of the Orthodontics Treatment Plan.

A treatment plan normally includes details such as:

– Estimated duration of treatment

– Total treatment costs

– Dental item number for treatment identification

– How you pay for the treatment (this can be in monthly installments or in a lump sum payment).

Your health insurance fund will provide you with a benefit offer upon presentation of a copy of the treatment plan. Such a quote is based on your treatment and your level of cover.

Benefit Limits and Waiting Times

Different health insurance funds offer different benefit limits; although they all have a similar waiting period of 12 months. A waiting period is simply the time you need to wait after your cover has started before you can claim a benefit. Remember to look for health insurance funds that offer the best benefit limits before choosing one.

Some funds offer an accrued benefit, others only have a fixed benefit. In the case of fixed benefits, you would be allowed to claim a certain amount each year, which would also have a total ceiling above which you would not be able to claim during your lifetime. A maximum lifetime limit still applies to accrued entitlements, but the annual payment amount continues to increase each year.

Always consider annual fees and lifetime limits when choosing the most appropriate coverage. You need to make sure that those specific amounts significantly cover your orthodontic treatment costs. This is especially true as the Australian Society of Orthodontists reveals that orthodontic treatment for both the upper and lower braces would range from $4,500 to $8,000.

Your choice of medical professional may affect your benefits

It is crucial that you understand the terms and conditions of your health insurance policy. In certain cases, the health insurance fund can provide a lower reimbursement if your orthodontics are performed by a general dentist instead of an orthodontist. Therefore, inform your fund in advance about your healthcare provider. Fortunately, many health insurance plans offer similar benefits, whether you’re getting treatment from an orthodontist or a general dentist.

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Given all the technical aspects that may affect your benefit, you should always carefully analyze all the terms and conditions that apply to your cover. This ensures that you get the most appropriate coverage for your Invisalign treatment.