• Age Restrictions:

  • At times, there may be specific age restrictions for coverage

  • Children and teens are typically covered

  • Adult coverage may also be included (18+ or 19+)

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• Lifetime Maximum Benefit (LTM):

  • Typically Insurance companies cover 50% of treatment costs, but only up to a certain amount (eg. $5000 treatment fee will result in a reimbursement of $2500)

  • The Lifetime Maximum Benefit or LTM determines the maximum amount the insurance will pay.  In the example above, if your LTM benefit is only $2000, then this will be the maximum amount reimbursed, not $2500

  • There are a few dental plans that may pay more or less than 50%.  This means that they will pay for Invisalign Treatment and other Orthodontic Services but once you have reached your LTM,  the insurance company will not reimburse any longer

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• Payment Schedule:

  • Many Insurance companies will reimburse Invisalign Treatment paid over time (eg. the 1st series of aligners in Invisalign Treatment may only take about 6 months, so you may be reimbursed over a 6 month period, typically with a larger initial payment and the rest over the next 5 months)

  • If you are no longer with the company and your benefits cease, you may no longer have coverage for treatment, even if you are mid-treatment

  • Some companies will reimburse Invisalign Treatment paid in a single lump sum

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• Reimbursement System:

  • Customers pay upfront for Invisalign treatment

  • Peak Smiles helps gather information about your dental claim for your insurance provider in order to submit the claim (ie receipts, Orthodontic Treatment plan, etc.) 

  • Your insurance provider will process your claim

  • You will receive reimbursement based on your coverage percentage, the maximum lifetime benefit, and the payment schedule on record.

  • If treatment only takes 6 months, you may receive insurance reimbursement all at once or over the first 6 months.

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• Treatment Estimate (Pre-authorization or Predetermination):

  • At times, the Insurance company may recommend a pre-authorization or predetermination to ensure coverage for your Invisalign treatment plan and to give approval 

  • If you complete the following form, we will gather insurance information and may be able to electronically submit this on your behalf: https://peaksmiles.me/insurance-form

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• Waiting Periods:

  • Some plans require a waiting period before orthodontic coverage begins.

  • Inquire about any waiting periods for braces.

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• Dual Coverage (Multiple Insurance Plans):

  • If you have dental benefits through 2 Insurance Companies, you may have coverage for Orthodontic treatment with one or both companies

  • Check for "coordination of benefits" or "non-duplicating clauses" which can affect your total coverage.

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• Changing Dental Plans during Invisalign Treatment:

  • Ensure the new plan will "take work in progress" and you may be able to get some reimbursement

  • Benefits may be prorated based on treatment time

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​Disclaimer: This information is provided as a general guide only and may not be applicable to all situations. Consult your specific insurance plan documents and your dental insurance company for detailed coverage information.

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