Does Smiledirectclub Accept Insurance?

Is SmileDirectClub Covered By Insurance?

Before insurance, SmileDirectClub aligners cost $1,950 (SmileShop and the impression kit cost $59 each). Depending on your insurance, this cost could be reduced by up to half.

SmileDirectClub provides a tool on their website to help determine how much your provider will cover. 

If your insurance company is partnered with SmileDirect, discounts will be applied to the price before checkout. 

SmileDirectClub has partnerships with the following providers:

• Aetna
• MetLife
• Anthem Blue Cross
• Anthem Blue Cross Blue Shield
• Empire BlueCross BlueShield
• Blue Shield of California
• UnitedHealthcare
• Dominion National
• Capital Blue Cross

If your insurance provider is not listed here, you’ll have to pay full price and request reimbursement afterward. SmileDirectClub will provide the necessary forms for you to file your claim.

SDC Aligners Overview

Founded back in 2014, SmileDirectClub is the oldest at-home clear aligner company, offering completely remote treatment monitoring. 

 There are two ways to start treatment:

1. Go to a SmileShop (physical studio) and get your teeth scanned by a licensed dentist or orthodontist.
2. Have an impression kit sent to your home

Treatment time for SmileDirectClub aligners is 4 to 6 months on average.

This is on par with most clear aligner brands but significantly faster than both Invisalign and braces. For comparison, Invisalign takes 6 to 24 months to straighten teeth; braces, 16 to 24 months.

What Insurance Plans Cover Orthodontics?

Many health insurers cover orthodontics for children, but orthodontic coverage for adults is less common.

Providers known for offering adult orthodontic treatment coverage include (but aren’t limited to):

• Delta Dental
• Humana
• Guardian Direct
• Aflac
• Cigna
• USAA

The amount of money you are reimbursed varies from one insurance company to another. A provider may cover either a certain percentage or dollar amount of your treatment. 

There are often lifetime limits on coverage as well.

Is SDC Covered Differently Than Invisalign and Braces? 

It’s complicated. SmileDirectClub is a clear aligner brand, just like Invisalign, which is usually covered by insurance in the same way as braces. 

However, when it comes to at-home clear aligners, some insurers consider them “DIY” treatment and decline to provide coverage. 

They may require an in-person appointment before they'll agree to cover medical expenses.

You may increase your chances of coverage if you start treatment in-person at a SmileShop location. The initial consultation is free of charge.

Ultimately, it’s best to check with your insurer directly prior to pursuing treatment.

Can SmileDirectClub Guarantee Reimbursement?  

SmileDirectClub doesn't guarantee you'll get reimbursed. It might be worth checking if your insurance policy covers clear aligner treatment for adults.

Note: SmileDirectClub won’t provide forms for you to file your claim until after you’ve made your payment. 

How to Check Your Coverage 

There are a couple of ways to check if your insurance covers aligner treatment. 

SmileDirectClub includes an easy-to-use eligibility checker tool that will check if your plan includes adult orthodontic coverage.

Many providers also allow you to check your coverage by logging into your account.

Finally, you can always call your insurance provider and check with them directly. There's usually a phone number for more information on the back of your insurance card.

There are also Consumer Assistance Programs (CAP) available for people who need help understanding their health insurance options in most states. Your state’s CAP can help you understand what benefits you’re entitled to.

What to Do if You’re Denied Coverage

If the denial was because your claim didn't qualify under your plan, you'll have to reach out to your insurance carrier directly for clarification. 

If you think your claim was wrongly denied, you have the right to file an appeal. First, the insurance company will review the denial internally. If they still deny, you can submit the appeal to an independent government body (this can be state or federal). 

Other Ways to Pay for SDC Aligners

If you’re worried your insurance plan won’t pay, SmileDirectClub offers several other ways to reduce the cost:

FSA/HSA

Many employer-sponsored insurance plans offer flexible spending accounts (FSA) or health savings accounts (HSA). SmileDirectClub accepts both of these as payment.

Payment Plans

SmileDirectClub allows you to pay for treatment via monthly installments. With SmilePay, you can make a downpayment of $250 and then make monthly payments of $89 per month for 24 months. No credit checks are required. 

Due to interest, this option may bring your total to as high as $2386 — much greater than the original $1,950 price. Interest rates with SmilePay range anywhere from 10 to 21% (depending on your state). 

You’re better off paying the entire cost up-front. Even if you have to borrow from a bank, the terms are likely to be significantly better.

Summary

• Before insurance, SmileDirectClub aligners cost $1,950.
• SmileDirectClub provides a tool on their website to help you determine how much your insurance provider will cover. 
• If your insurer is partnered with SmileDirectClub, you may be able to have discounts applied up-front.
• Treatment with SmileDirectClub aligners takes 4 to 6 months on average.
• Some insurers may insist on an in-person appointment before paying.
• SmileDirectClub won’t provide forms for you to file your claim until after you’ve paid.
• Check with your insurer before paying for treatment.
• You can appeal denied claims.
• SmileDirectClub accepts both HSA and FSA.
• You can pay in installments, but it will be significantly more expensive.