Invisalign Treatment: Dealing with Insurance Denials

In the past, individual insurance companies denied coverage for Invisalign treatment, either claiming that medical necessity was not established or that the individual indication was not given. At times, these insurance companies produced medical opinions from so-called consulting dentists intended to support the companies’ refusal to cover the treatment.

Meanwhile, initial court proceedings and expert assessments have been concluded that recognize the Invisalign procedure as mainstream medicine in favor of patients, with corresponding coverage obligations for the insurance company. In extension of the DGKFO’s indication catalog from January 2004, the treatment of children is now also recognized when recommended by a certified orthodontist. Through corresponding court expert opinions, it has further been clarified that even in cases of only minor misaligned teeth, treatment may be not merely cosmetic but specifically medically indicated. Finally, it should be emphasized that when assessing whether you have a claim for cost reimbursement for Invisalign treatment , you can insist that only a certified specialist in orthodontics makes the relevant determinations.

 

From all this, it is evident that the rejection practices of the aforementioned insurance companies in the past were at least highly questionable and would no longer occur in this way today. In fact, Invisalign treatment is now regularly recognized and covered in accordance with policy terms.

This notice is issued on behalf of an interest group consisting of patients, practitioners, and other supporters of the procedure. It is prompted by the fact that it can now be documented that the blanket rejection of your orthodontist’s therapeutic efforts as allegedly “medically unnecessary” was itself not medically justifiable.

Case number: 14 S 388/03 + 2 C 652/03

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