What do you mean my insurance is not going to cover my orthodontic treatment????????????

Be-in-the-know! This is a “Hot Topic” with Smile Direct, Candid and other mail-in orthodontics…

(which we absolutely do not recommend- see more about that by reading on to the end of this post.)

Insurance company representatives are expressing real frustration with these mail in aligner services. What’s happening is that patients are under the impression that their insurance policy will cover this procedure under their orthodontic coverage clause. Most of the carriers have a policy stating that coverage is for services provided in-office. This has left Smile Direct, Candid and other companies customers scrambling for coverage and using random or shared provider IDs to have their claims processed. Patients may not realize they’re committing insurance fraud by using a fill-in-the-blank provider identifier.

An insurance coordinator shared that they have been receiving calls from Cigna to verify a patient’s status in the office. Of course, when they do call, they are finding that they are not a patient of record due to using a shared provider ID and the patient is trying to get coverage for orthodontic treatments done at home. This is not the first time I’ve heard of this and unfortunately, it won’t be the last.

What should the patient do?

Seek treatment in-office with a qualified provider. This way your care is monitored by someone trained in orthodontics. They can provide the same limited type of treatment as these mail-in orthodontic companies or can inform you that you may need further treatment if limited orthodontic treatment does not meet your esthetic goals or work within your bite for long term success. They have the ability to spread out payments like these mail-in orthodontic companies, they have the ability to actually provide you insurance benefits that you are paying for already and they have the ability to use different companies and products that are suited for your case. Most aligner cases need some axillary products to make the treatment go as planned that these mail-in companies cannot provide, but a qualified provider, like Dr. John Montoya, can.

If you’ve considered using a mail in ortho company before, and especially if you’ve been hoping to maximize your dental insurance benefits, contact our office today for a FREE consultation where you can get a straight story – AND straight teeth!

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Dr. John Montoya is your family friendly dentist that specializes in General, Cosmetic, and Implant dentistry in Boulder, Colorado. Schedule your appointment or Contact us today!


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