Does Private Health Insurance Cover Orthodontic Treatment?

Does private health insurance cover orthodontic treatment?

The short answer: it depends on your policy. Private health insurance and supplementary health insurance (TSS, a Turkish top-up plan) define the services they cover through the policy terms. In most policies, dental treatment is not part of the main coverage but is provided through a separately added dental coverage. Orthodontics may be included in this coverage, may be limited, or may not be included at all. Conditions can differ even between different products of the same insurance company.

So do not assume that your insurance will cover treatment just because a relative's insurance did. The only reliable source is your own policy and the written answer your insurance company gives you. This page does not provide information about any specific company or product; it only explains, in general terms, the questions you should ask and the documents commonly requested in the process.

Which conditions determine orthodontic coverage in a policy?

The headings in policy documents that affect orthodontics are usually the following. Only your insurer can tell you which apply to your policy:

• Whether there is dental coverage: If your policy has no dental treatment coverage at all, orthodontics is usually excluded as well.
• Whether orthodontics is specifically mentioned: Some dental coverages include procedures such as fillings, root canal treatment and extractions but exclude orthodontics.
• Age condition: Orthodontic coverage may be defined only for insured people under a certain age.
• Annual limit and co-payment: Even if there is coverage, there may be an annual cap or a share you have to pay.
• Waiting period: Orthodontic coverage may not be usable until a certain period has passed after the policy starts.
• Pre-existing conditions: Dental and jaw problems that existed before the policy started may be excluded.
• Treatment method: Fixed braces and clear aligner treatment may be assessed differently in the policy. Be sure to ask about this distinction.
• Assessment of esthetic purpose: Some policies cover only orthodontic treatments for which medical necessity is shown; in this case, the orthodontist's report becomes important.

What should you ask your insurer before starting treatment?

It is important to call your insurer before treatment starts, not after. Some policies require pre-approval (provision) and may not consider procedures done without approval afterward. You can send the following questions to your insurance company or agent and, if possible, ask for the answers in writing (by email or message):

1. Does my policy include dental coverage, and is orthodontics included in it?
2. Are clear aligner treatment and fixed braces assessed the same way?
3. Is there an age limit, waiting period or annual limit for orthodontics?
4. Do I need pre-approval before starting treatment? If so, which documents are required?
5. Is payment made through a contracted provider, or do I pay and then claim reimbursement?
6. If treatment lasts longer than a year, does coverage continue when the policy is renewed?
7. Is the retention appliance (retainer) after treatment covered?

For topics you would like to ask your orthodontist before the examination, you can also use the orthodontic examination question list page.

Which documents might insurance companies request?

The documents requested vary from insurer to insurer and depending on whether it is the pre-approval or reimbursement stage. In general, the commonly encountered documents are:

• Invoice: An invoice issued in the patient's name showing the procedures performed and the amount. Some insurers ask for each procedure item to be listed separately.
• Orthodontist's report or treatment summary: A document explaining the diagnosis, the reason for treatment, the method to be used and the estimated duration.
• Treatment plan: A breakdown showing the planned stages and the number of sessions.
• X-rays and records: Panoramic and cephalometric X-rays, intraoral photographs or digital scan images.
• Proof of payment: A receipt or bank slip showing payment for a reimbursement claim.
• The insurance company's own form: Some companies use a claim form that the orthodontist must fill out.

The clinic issues the invoice for the treatment provided and, on request, can also prepare documents such as a treatment summary or report. If your insurance company has a specific form, bringing it to the examination speeds things up. Whether the documents will be accepted by the insurer and how much will be reimbursed is the insurance company's decision; the clinic cannot make any commitment on this.

Why is the orthodontist's report important in the insurance process?

For policies that cover orthodontics only in cases of medical necessity, the insurance company wants to understand why treatment is needed. The orthodontist's report answers this question: it explains in neutral language the current state of the teeth and jaws, the type of bite problem (for example deep bite, crossbite or severe crowding), its possible effects on chewing, speech or oral hygiene, and the recommended treatment.

The report is based on the findings at the examination; it is not written to influence the insurer's coverage decision. For general information about bite types, see the bite classes page. If you ask your insurer in advance which details the report should include, it becomes easier to prepare the document completely in one go.

How do I find out the insurance coverage for my child?

In children, orthodontics may be spread over more than one stage, such as appliances used early on and the main treatment later. These stages may be assessed separately in the policy. As a parent, it is helpful to ask your insurer whether your child's policy has an age limit for orthodontics, and whether early treatment and later treatment count as a single file or as separate claims. For information about early treatment, see the early orthodontic treatment page.

Does the clinic have an agreement with an insurance company?

Because lists of contracted providers can change over time, no company names are given on this page. To find out the current situation regarding your insurance, you can ask both your insurance company and the clinic when making an appointment. Where there is no agreement, some policies work by you making the payment and then claiming reimbursement with documents. Your insurer will tell you which route applies to you.

What are my options if insurance does not cover it?

Your insurance not covering orthodontics does not mean you cannot start treatment. The fee is determined by the scope of the case, the length of treatment and the method; it is provided in writing after the examination and planning. You can find the factors affecting the fee on the clear aligner cost page. If you would like to weigh the differences between clear aligners and fixed braces, the clear aligners vs braces comparison can guide you.

Public options and the conditions under which SGK (Turkish Social Security Institution) covers orthodontics are a separate topic; for details, see the clear aligners at public hospitals page.

I have health insurance from abroad; is the process different?

Some foreigners living in Ankara and people working abroad have international policies. Orthodontic coverage in these policies also varies, and reimbursement claims are mostly made with documents. It is recommended that you ask your insurer which languages documents are accepted in and what information the invoice must contain. Communication at the clinic is possible in Turkish, English, German and Russian; details are on the orthodontics for foreigners page.

What should you watch out for in the insurance process?

• Ask for a written answer: Information received by phone may later be interpreted differently.
• Keep copies of documents: Invoices, reports and correspondence may be needed throughout treatment.
• Note the policy renewal date: In long treatments, conditions may change after renewal.
• Take a job change into account: A group policy provided by your employer may end when you change jobs.
• Do not forget the retention phase: The retainer and checkups after treatment may be assessed separately; the retainer page explains this phase.

The records taken at the examination and the treatment plan prepared form the basis of the documents your insurer may request. You can read which records are taken at the first examination in our article on the first orthodontic examination.