Does blue cross blue shield cover smile direct club

Blue Cross Blue Shield (BCBS) is one of the nation’s largest health insurance providers. They have numerous companies under their umbrella and insure millions of Americans. But their orthodontic coverage isn’t quite as widespread. If you’re considering braces, Invisalign, or at-home aligners, you might be wondering if your BCBS plan will help you out. The answer: it depends.

If you have Blue Cross Blue Shield, there’s a chance that they’ll cover your clear aligner or braces treatment, but there’s also a chance they won’t. Before you dive into treatment, read this guide for an in-depth look at BCBS’s coverage and instructions on how to use it.

Table of Contents

1. Average Costs Before Insurance
2. What Does Dental Insurance Usually Cover?
3. How to Get Orthodontic Coverage with Blue Cross Blue Shield
4. Blue Cross Blue Shield Invisalign Coverage
5. Blue Cross Blue Shield Braces Coverage
6. Blue Cross Blue Shield At-Home Clear Aligners Coverage
7. How to File a Claim
8. Other Options If You’re Not Covered
9. Conclusion

Average Costs Before Insurance

Orthodontic treatment prices certainly aren’t cheap, but they can vary significantly based on your condition’s severity, your dentist or orthodontist’s rates, and the type of treatment you choose.

Invisalign

On average, your Invisalign treatment will cost somewhere between $3,000 and $8,000. That’s a pretty big range, but only because the price is subject to several influences, including your condition’s severity, treatment length, dentist’s expertise, and even where you live. Read through our true cost of Invisalign guide for a closer look.

Although Invisalign pioneered mainstream clear aligner treatment, they’re no longer the only producer. ClearCorrect hit the scene in 2006 and has been a worthy competitor ever since. They charge less for lab fees than Invisalign does, so their prices can be slightly lower, often in the $3,000–$5,000 range (although up to $8,000 is possible too). Then there’s SureSmile, who offers an affordable, highly customizable alternative that typically costs $2,000–$6,000, and 3M Clarity, who makes some of the most powerful aligners out there and often costs $3,000–$8,000.

At-Home Clear Aligners

While Invisalign must be administered in a dentist or orthodontist’s office, at-home aligners let you complete treatment (you guessed it) at home. A remote dentist will design your treatment and you’ll receive all of your aligners in the mail, then follow your treatment plan to gradually shift your teeth.

The appeal of at-home clear aligners is largely because of their affordability. They’re often thousands cheaper than in-office clear aligner treatments, around $1,200–$2,500 on average. Unlike Invisalign and ClearCorrect, home aligners come at a flat rate. The only difference is which company you choose. For example, SmileDirectClub is always $1,950 while AlignerCo is $1,145.

Our top-ranked provider is Byte, which costs $1,895 for standard treatment and $2,295 for Byte At-Night. They don’t have the absolute lowest price on the market, but their treatment takes just four months on average, and they put a lifetime guarantee on your smile. Plus, Byte will walk you through the entire insurance process, from initial coverage checks to claims and anything else you might need, making it a lot easier. Check out our guide on insurance coverage with Byte for more info.

Braces

The most time-tested orthodontic treatment can also be one of the most expensive. Traditional braces typically fall somewhere in the $4,000–$6,000 price range, although that price depends on a few factors (see our guide on the true cost of braces). Like Invisalign, the exact amount depends on your condition’s severity, your orthodontist’s rates, and where you live.

It also depends on the type of braces you choose. You have a few options: traditional braces, lingual braces (which sit behind the teeth), and clear/ceramic braces. Specialty braces (lingual, clear) often cost more than traditional ones. Lingual braces, for example, can cost up to $10,000.

What Does Dental Insurance Usually Cover?

Insurance companies often classify dental procedures into one of four categories: preventive, basic, major, and cosmetic.

Most plans cover 100% of your preventive treatments like cleanings. They might also completely cover basic treatments like fillings, gum disease treatment, and root canals, or they might cover a higher percentage of the price. Major treatments like crowns and bridges are usually covered at a lower rate, sometimes around 50%. Plans will rarely cover cosmetic procedures, like whitening, veneers, and tooth shaping. Of course, the percentages for each category depend on your specific plan.

Notably, some providers consider clear aligners and braces cosmetic forms of treatment, and others classify them as major procedures. Some plans will include orthodontic benefits that can help cover the cost of braces, aligners, or other procedures, while others do not.

Different providers and plans cover different procedures, so you shouldn’t assume that you’ll receive coverage for your treatment just because you have orthodontic benefits. Additionally, sometimes this coverage comes with an age limit or an annual or lifetime limit.

It’s also important to know some insurance terminology to understand your plan, like:

• Deductible: The amount you’ll need to pay out of pocket before insurance picks up the tab. If you have a $100 procedure, but your deductible is $500 and you haven’t paid any of it yet, you’ll need to pay for the entire procedure.
• Copay: Short for copayment. A set amount that you’ll pay for certain covered treatments. Copays can vary based on the procedure.
• Coinsurance: The percentage of treatment costs you’ll need to cover after you’ve met your deductible. It also varies based on the procedure.
• In-Network vs Out-of-Network: Dental providers often partner with insurance companies to provide “in-network” coverage. When your dental provider is in-network with your insurance provider, coverage rates are typically higher and your dental provider will handle the insurance paperwork for you. Coverage rates for out-of-network care are often lower, and you may need to request reimbursement from your insurance provider directly.

How to Get Orthodontic Coverage with Blue Cross Blue Shield

First, we should note that Blue Cross Blue Shield isn’t a single company. Rather, it’s a “national association of 36 independent, community-based and locally operated Blue Cross Blue Shield companies.” This includes subsidiaries like Anthem and Empire. Your insurer’s name might be slightly different, but you’ll still receive BCBS insurance, although the plan details might vary.

Second, orthodontic coverage isn’t something you need to buy separately — it’s simply included in certain BCBS plans. There are two ways to get enrolled in a suitable BCBS plan: through your employer, or by purchasing an individual plan.

About half of all adults in the US receive dental insurance through their employer (or that of their spouse). There are a couple of advantages to enrolling in dental insurance through an employer plan. For one thing, insurance premiums get deducted directly from your wages before tax, reducing what you owe in taxes. For another, employers often contribute toward the cost of their plans, which results in lower premiums.

However, there are also some important drawbacks with employer-sponsored dental plans. First, you’re limited to the plan options offered by your employer. This can be especially problematic if you’re interested in braces or clear aligners, as many dental insurance plans do not cover orthodontics, or offer very limited coverage. Second, employer-sponsored dental plans are often bundled together with health plans, so you may need to wait for an “open enrollment” period to modify your plan. Lastly, many companies simply don’t offer dental insurance at all!

Fortunately, even if you receive health and/or dental coverage through your employer, you can always invest in an individual plan that covers orthodontics, too. And unlike buying standard health insurance, you don’t have to wait for an open enrollment period to purchase an individual dental/orthodontics plan — you can enroll at any time of the year. Blue Cross Blue Shield offers individual plans in most states, but we recommend shopping around as other providers may offer more generous orthodontic benefits in your state.

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Blue Cross Blue Shield Invisalign Coverage

There’s a ton of variation in BCBS plan options because there are so many different companies under the umbrella. Your plan’s details will depend on which company operates in your state and if you’re receiving insurance through your employer, which ones they’ve chosen. No matter where you’re located, BCBS’ basic PPO plans rarely cover Invisalign, or they only cover treatment for anyone under age 19.

But some of the more expensive plans might cover up to 50% of comprehensive orthodontia for adults too. In other cases, you might be able to add orthodontic coverage to your plan, but that depends on which plans your company offers.

Since ClearCorrect, SureSmile, and 3M Clarity are similar to Invisalign, they might also be partially covered, depending on your plan. Six Month Smiles typically treats milder cases, so it’s almost always considered cosmetic, but not always! You’ll have to check with the company and your dentist to find out.

Braces are in the same boat as Invisalign. BCBS often considers adult orthodontic treatment cosmetic, so basic plans won’t usually cover it. When they are covered, it’s usually around 50%, and there’s often a lifetime limit, although this depends on your plan. Other companies allow you to add orthodontic coverage to any plan for an extra fee. Again, there is a lot of variation between companies and plans, so you’ll need to check with your provider to know for sure.

Lingual braces and clear braces are covered the same way since they’re used to treat the same kinds of conditions. Six Month Smiles, however, is a short-term treatment for milder cases, so their braces might not be eligible. You’ll need to check with BCBS to find out.

Remember that you’ll need to get treatment from an in-network dentist or orthodontist to receive the full amount for your coverage.

Blue Cross Blue Shield At-Home Clear Aligners Coverage

It might come as a surprise, but sometimes BCBS plans cover home aligners. Anthem and Empire have established partnerships with Byte and SmileDirectClub, so those treatments are considered in-network. This doesn’t mean that every Anthem and Empire plan will cover home aligners. Plans that don’t have orthodontic benefits likely won’t cover at-home aligners either. But let’s say you have an Anthem plan that includes orthodontic benefits as well as treatment from Byte or SmileDirectClub. In that case, you might be covered.

What about BCBS plans that aren’t under Anthem or Empire? You could still get your treatment covered, but again, you’ll have to see if you have orthodontic benefits.

How to File a Claim

For in-office treatments like braces and Invisalign, your dentist or orthodontist’s office will file an insurance claim on your behalf, so you don’t have to worry about any paperwork or other correspondence. They’ll only do this, however, if they are in-network with BCBS. If you choose an out-of-network dentist or orthodontist, you may need to file the claim yourself. If you receive insurance through your employer, their human resources department can walk you through the process.

BCBS has numerous subsidiaries that operate in different states, and each one has its own forms and procedures. But many of those companies have claim filing instructions and forms on their websites. Just search for your particular company’s claim form.

Home aligner companies provide varying levels of insurance support. Byte, for example, will walk you through the entire process. They’ll fill out your claim so that there are no mistakes and they’ll also handle any ongoing communication or appeals with the insurance provider. SmileDirectClub will also help you check on your coverage and file claims, and most times, they’ll communicate directly with your insurance provider as well.

Other companies leave the insurance process up to you. In these cases, you’ll need to download the correct claim form for your company and fill it out completely. Contact the home aligner company with any questions, because a single mistake on your form can get your claim denied.

After you’ve filed a claim, the insurer will process it in a few weeks, or it could take a couple of months.

Other Options If You’re Not Covered

What if you’re ready to get started with braces or aligners, but your current insurance plan doesn’t cover the treatment you want?

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use either to pay for your treatment. These accounts deduct money from your income before taxes and let you use it for qualifying medical and dental expenses. They’re often an option with employer-sponsored plans, and even if you received partial coverage for your orthodontic treatment from Blue Cross Blue Shield, you could use an HSA or FSA account to pay the remaining balance.

If you can’t find coverage, you can always look for other ways to make the price tag more manageable, like financing plans. Dental and orthodontic offices will usually offer payment plans, as will most at-home aligner companies, although a credit check might be necessary to qualify. Or, you can check out third party options like CareCredit, which provide financing specifically for medical and dental expenses (these plans often require a credit check too).

Conclusion

The top takeaway is that you can receive coverage for your adult orthodontic treatment. BCBS is a relatively friendly insurer for orthodontic treatment. Their Invisalign and braces coverage is comparable to other providers, but where they shine is in their partnerships with home aligner companies. If you have BCBS insurance and you’re pursuing at-home aligner treatment, you have a better chance of receiving coverage.

Insurance can sometimes seem like an enigma, especially when it comes to orthodontics. But once you know the ins and outs of your plan, you should have a good idea about which treatments will receive coverage and how you can take advantage. It’s always a good idea to consult your dentist, orthodontist, or at-home aligner provider about insurance coverage before diving into treatment.