hey it's dr amanda with straight smile solutions street smile solutions.com and today i'll be
talking about invisalign lab fees not what the lab fees are because i have a video on that but
i'm going to be talking about how it works with revisions refinements mid-course corrections are
you going to get charged for it are you not and i'm only going to be making this video for doctors
in the united states if you are in australia uk canada eu other countries you will have different
menu of services totally different fees and the way it works is going to be totally different
i don't have access to that because i am an orthodontist in the u.s so i only have access
to what my fee is so i can't really speak for that i'm assuming it's relatively similar um in terms
of how it works but for example moderate in the us is 20 aligners moderate in canada is 24 laners
so everything's going to be slightly different but you know if you're a patient and you're listening
to this great youtube is all about access to uh information but this is really directed towards
the doctor whether or not your doctor is including a refinement revision or mid-course correction is
between you and your doctor if you sign paperwork you want to go back and dig up your contract and
usually they write it in there if you didn't well then far as i'm concerned it's included because
if you didn't say it wasn't included it's included that's the way things work um so you just need to
say you're not satisfied and get that refinement your doctor will have some type of fee possibly
but that's your doctor probably not planning the case properly and or not guiding you on compliance
now if you are outwardly non-compliant you aren't coming for appointments you aren't doing your
virtual check-ins you want wearing your trays as directed and they have documentation of that well
then there's a reason you might need to pay for something else but again this is between you and
your doctor i'm not getting involved in that i'm just talking about to the doctor so they know and
really it comes down to many different things first of all for the most part i can tell you
because i've personally either directly done or indirectly been involved in maybe five thousand to
ten thousand invisalign cases over my career which basically spans back to when this line started
back in 1997. well you know i graduated dental school in 2001 but i mean we actively got started
then so i've seen a lot of invisalign cases it's come a long way like a long way it used to be a
pretty crappy product i only used it if somebody forced me to use it because i just didn't get the
outcomes i wanted now i can get better outcomes with invisalign than i can with braces for the
vast majority of treatments um there really is nothing i can't do with invisalign as long as i
know how to do it now doesn't mean that your lab tech knows what to do you have to tell them what
to do and how to do it and there's all different work arounds so that's something we're really good
at here at straight smile solutions educating you on how to optimize your clin check so that you can
get the best possible outcomes so there's really no reason you should be saying no to invisalign
cases at all as far as i'm concerned i also agree with the line technology now remember i don't work
for online technology i get zero benefits from promoting their product i just really find their
product to be a great product as well as many other elena companies that are out there there
are other ones that do just as well as invisalign that are maybe white label and other things you
just kind of under they're underground and they're a lot cheaper so feel free to reach out to me if
you want to know more about that you'll save a ton of money but you won't get all the benefits like
the educational content um the training um there's a lot of other benefits that align has really
improved over the last five years or so so i still like it i can tell you from my own daughter we are
doing in design for her she's 11. it's a very very very difficult case like probably harder than i've
ever seen of any case and it's a surgical case and my husband and i made the choice to use invisalign
um that was a really i was thinking about braces which i know we could have done
but after i went to the summit this past november and i saw a similar case that i've never seen
before i was eyes wide open i said we're gonna do it she's so excited about getting her invis stay
tuned we're going to get it in the next couple weeks it's going to be a long case it's probably
going to take a couple years but it's going to be amazing and i'm excited to publish the case um
together with the oral surgeon who i'm treated planning with but anyways um let's talk about
those lab fees do you get a revision refinement do you not how much is it going to cost so you really
have to be aware of these things when you start the case because cases do have expiration dates
um they also have all kinds of limitations and certain things have to be done before
the exploration date okay so if you personally i always tell everyone always work up every case
is a comprehensive case every case don't don't ask me if it should be expressed no it's comprehensive
every case is comprehensive that's gonna make your life so much easier with revision basically it's
a non-issue because there's no reason you can't finish every case within five years so that really
takes all the stress out of everything now i can look at a case and tell you this is probably going
to be eight aligners this is probably going to be 10 okay so sometimes you can downgrade it but
anytime you downgrade it first of all you still need to optimize the clinch check right just with
just because they tell you could be done in eight doesn't mean it's predictably done at
eight so usually i take whatever they give me and i add at least an extra 50 more aligners on
if not double every case so if they say eight it's now a 16 for me it just makes it more predictable
smaller steps in between each aligner if somehow it's crazy loose it's a teenager you might be
doing changes every three to four days and that's fine but remember it's not a flat seven day change
that's where you start if the case isn't tracking if they didn't get it seated if they need to use
their chewies to get it seated your seven days starts once they get it seated so one aligner
might be seven days one liner may be five days one liner might be two weeks it's gonna change and if
you educate your patient and provide the virtual resources so that you can check in every aligner
you will not have revisions and refinements it'll be the exception not the rule it'll completely
transform your aligner practice it is the biggest mistake that most dentists make orthodontists have
it down but general dentists to do ortho they don't have it down at all and now on top of it a
line has virtual resources included so you're not thinking if you're not using what they have yes
i mean you can give them the whole box of aligners and say check in every aligner
and if they're not doing it you're going to send them a warning letter and warn them that they
need to check in at realigner ideally you're going to do almost like a dm do go no go kind of thing
where they don't change to their new aligner until they show you the old aligner through the virtual
check-in you give them the thumbs up which means you're gonna have to check your emails every day
you can train an assistant to do it you know and that's what most orthos do and then they will
accelerate it or um upgrade it if needed you know to the doctor if they have a question it's really
easy if the patient has elastics or bite issues you're gonna be taking pictures with the aligners
in with the aligners out slightly open as well as checking the bite with the aligners out
because there's a couple different plates of space you're going to be thinking about but
um ultimately yeah i mean this really shouldn't be a problem okay so let's go through comprehensive
so again i can't show this to you because their legal team will come after me but i'm just
going to read it because i'm allowed to do that invisalign comprehensive i think all cases should
be comprehensive i don't think you should even be touching the express cases if it's a really
easy case just use white label unless you're really trying to build now i know some doctors
that are just trying to build their point so they can get the lab discount great even more reason
because you're gonna get a thousand points per comprehensive and promoter in case so do them all
as a comprehensive maybe moderate um comprehensive lab fee 1879 unless you have a volume discount
you get a reasonable amount of additional aligners included in the treatment place they don't really
define what it is for up to five years i've never heard of any doctor being turned down
for refinements so um you know that's good and as long as you can document it um five years after
the shipment date of the first set of aligners okay so if i go and accept my treatment plan
today you know early 2020 if they ship in two weeks my five years starts at that shipment date
so you need to note that down i mean you shouldn't be going over five years as long as you're using
virtual check-ins keeping your patients on a tight leech if they disappear or vanish you start
your series of three um discontinuance letters certified and after the third one bye-bye 30 days
bye you know i'm no longer responsible for your treatment maybe you're not billing anymore either
but that makes things really easy keep your patient on a tight leash it you know
you really have to have a spreadsheet going of your invisalign patients are they checking in
are they not where are they did i lose them did they ghost me because if they start ghosting you
need to dismiss your patient okay because you're you're still as long as your patient's going
through treatment you're responsible for that patient no matter what for those five years okay
invisalign moderate i'm okay with moderate i'm fine with that labview is only almost like a 200
difference it's really not that big a deal um you only get up to 20 aligners and you only get one
refinement okay that's it one so that's the limit so you better pick an easy case and you better
pick a compliant patient i've seen people get stung on moderate cases that needed more than one
refinement you're gonna end up paying more than you would have paid for comprehensive at least now
you get the same amount of points from moderate so i'm okay with it before i was like eh why would
you want to do it but um so you get one set they call it additional liners but it's a refinement
or mid-course correction up to 20 trays okay um it's included for up to two years after the
shipment date so two years okay which shouldn't be a problem because if you're doing 20 aligners at
one week each that is right 20 weeks so why would you be going 50 100 weeks right that's five times
slower so that really shouldn't be a problem but again keep your patients on a tight leash
if you need more refinements than that you will pay 130 per additional set but you can't do it
after the treatment expiration date which is three years after the first shipment okay so after the
two year mark of the shipment you're going to pay 130 per refinement or mid-course correction but
once you get to the three years afterwards no more okay that's a brand new case so keep that in mind
again this really should not be a problem but if you lose your patient or they ghost you
that's why you need to have a really good contract and contracts or things that we have
in our store you can take a look at again run your contracts by your legal team we're not lawyers but
they're things that have worked for us you know everyone has their own dental practice act but
obviously if you're doing a moderate or an express case you want to clearly say what their treatment
expiration date and let the patient know that if the treatment goes over that they will have
an additional fee and you really should you can say what it is or don't say what it is but if
you don't say that and the case isn't done doctor you're responsible you're paying for that okay so
that's the way it works because if they appeal with the insurance company or the dental board
you're in trouble okay next so that was moderate so i'm okay with moderate next one is light i
almost rarely use light it would have to be in a crazy simple case that i think i can do in less
than six aligners that gives me up to 14 that's wiggle room if the patient's not that compliant
um again similar to the way moderate works you get one revision refinement for one year after
the shipment date after the two years up to two years you can have more refinements at 1 30 a pop
but once the two years after the shipment date comes it's expired can't do anything
additional fees so same thing but instead of two and three years it's one in two years and your
refinement is only up to 14 aligners it better not be more than that remember again i'm going
to bring up another thing a lot of people that are doing light or moderate cases they're doing
anterior only movement they're not doing posterior movement unless you've figured out that you know
that patient only wants the anterior only movement you're feeling less limited not comprehensive
for insurance you've documented you've had them sign the limited contract you should always have
all patients doing anterior only sign a limited contract i have copies in my store if you need it
it's free for our clients or our subscribers if you are a subscriber and you are listening to
this email me and i will send it to you otherwise the fee is 20 per document um you can get that
from our store but so what happens very often with patients who are doing express light or
moderate you know the setup maybe said you could do it and that less amount of aligners but then
the patient's like i don't like this overjet i want to fix it well now you're in trouble
because you started the case as a express moderate or light well the comprehensive or the ideal can't
be done within that now you're gonna have to do a brand new case or maybe you can beg a
line to upgrade your case to comprehensive it's going to cost more it's going to take more time
or you're going to have to do a bunch of refinements which is going to cost more
so of course you're going to want to revise the contract and have the patient pay more
but if you made the mistake of billing d80 80 d80 90 instead of the limited billing oopsies you're
now responsible because you didn't bill correctly you build the insurance as a comprehensive but
yet you didn't offer comprehensive treatment or pick a comprehensive product through invis
you're going to eat that lab fee now okay so you gotta be careful and again i see
this happen every single day with doctors who i talk to so just things to keep in mind okay
so let's get lastly we did um comprehensive we did moderate we did light now let's talk about express
i basically don't use express at all anything in the lightest it's going to be is going to be
light it's just not worth the trouble to me so remember i get confused too um light lab fee is
about thirteen hundred dollars okay express they have express five express 10 and express seven
um i think they're phasing out just the five and the ten the five and ten of the most limited seven
is actually better i don't use them like i said so i'm gonna tell you don't use them um lab fee
on express seven is seven hundred dollars so it's five hundred dollars less than light i get it but
you're only getting up to seven aligners upper and lower um ten uh maybe i generally don't lab
fees about a thousand dollars um 10 is like bs because any type and same thing with five any
type of refinement you're gonna do is gonna have a fee there's no freebies okay so everything's
gonna cost you and it's very very limited okay so within one year of the refinement fee date okay
so and you only get one refinement total you can't have multiple refinements for 130 you get
one and it's within one year so no more after that it's just so limiting i think you're making a huge
mistake doing that it's just not worth it i would just do i would just do the light um express seven
is actually more relaxed you get one refinement included but you only you have to use it within
six months so again gotta keep your patient on a tight leash um after the six months between
six months and one year after shipment there's a hundred and thirty dollar fee and after that one
year no more that's all you get lobby is seven hundred dollars so yeah that's pretty much it
hopefully that was helpful for you i know it was helpful to explain it for me to go over it again
pick wisely have an optimized treatment plan know what you're doing with your treatment plans don't
trust your tech they don't really know what they're doing for the most part sorry but
they don't um if you don't know what you're doing there's a lot of great courses out there of course
our course is one of those courses you can also if you're on a budget you can check out our book
which is only 9.99 for kindle 49 for paperback you can find it at amazon it's on my website if you
want to find the link straightsmilesolutions.com it's pretty obvious it's in a banner
um sometimes we give out promos where we give away books but it really depends
so um if you've got one of those postcards in the mail yeah redeem it for sure
but that will be helpful for you of course we've got a zillion youtube videos it's all
free go ahead and access that there are a few courses i do recommend my course is one of them
um we're more of like a one-on-one hands-on course where we help you with your cli with your actual
patient if you're looking for a more like didactic kind course um that's not me that's not what we do
but i can recommend a few if you want to give me a call i've i had a few where some doctors were
looking for that and that's maybe i wasn't very fit for them and they were really happy about it
so but there's also a lot of bs courses out there where i've seen terrible outcomes so i'm not gonna
say it because i don't need people's lawyers attacking me but i'll talk to you one-on-one
about if you have a question all right thanks so much hopefully that was helpful take care