#Orthodontist #Insurance #Invisalign
Understanding Insurance Pre-Determination for Invisalign
If you’re considering getting Invisalign treatment from an out-of-network orthodontist, you may have encountered the issue of not being able to get a clear estimate of your out-of-pocket costs. This article aims to shed some light on the situation and provide some guidance on how to navigate through this process.
What is a Pre-Determination?
A pre-determination, also known as a pre-authorization or predetermination, is a process where the orthodontist submits a treatment plan to the insurance company to get an estimate of what will be covered and what the patient’s out-of-pocket costs will be. This serves as a helpful tool for both the patient and the provider to understand the financial aspect of the treatment before it begins.
The Dilemma: No Pre-Determination Available
In your case, the orthodontist is claiming that they do not do insurance pre-determination for Invisalign estimates because they do not submit a claim until treatment is started. This may seem like a red flag, but it’s not necessarily uncommon. Some providers prefer to wait until treatment is initiated to submit claims to ensure accuracy in billing.
What Can You Do?
If you’re feeling frustrated and unsure about your out-of-pocket costs, here are some steps you can take to get a clearer picture:
– Ask for a detailed breakdown of the costs associated with your Invisalign treatment, including the cost of the aligners, any adjustments, and follow-up appointments.
– Contact your insurance provider directly to inquire about coverage for orthodontic treatment and what information they need to provide an estimate.
– Consider seeking a second opinion from another orthodontist who may be willing to provide a pre-determination.
Final Thoughts
While it can be a frustrating experience not being able to get a concrete estimate of your out-of-pocket costs for Invisalign treatment, it’s important to communicate openly with your orthodontist and insurance provider to ensure you have all the information you need to make an informed decision. Don’t hesitate to ask questions and seek clarification to avoid any surprises down the road.
Is there *no* ortho that’s *in network*?
That seems like the obvious solution.
I’ve had the same situation with my ortho and jaw surgery estimates. All the ortho can really do is give some of the possible procedure codes and then your insurance can let you know what kind of stuff may be eligible for coverage, but it’s all very up in the air. I just ended up having the ortho giving me a kind of worst case ballpark for full cash price, and then he said he’d do everything he could when writing the claim up for insurance.
Find another ortho. Start with asking your insurance for a list of in-network providers, but confirm with the provider as well before the appointment.
This is weird. I’m finishing Invisalign and was quoted 6k. I have a similar plan, I called up my insurance and they told me 3k max coverage, and verified my dental office was in network.
Pretty simple math, I was billed 3k after insurance.
Why are you going out of network? You should stay in network for coverage lol
Sham. You should get a quote for the full cost of treatment up-front. Insurance kicks in part, you’ll be on the hook for the rest. Most orthos offer payment plans.