Dental insurance benefits, especially for restorative work like fillings, can be very difficult to understand. The benefits summary may state that fillings are covered at 80%, but due to several factors this is not usually the case. Most dental insurance companies use what is called a “Usual, Customary and Reasonable” fee guide. This means that the insurance company sets their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges. The insurance company pays its percentile based upon its UCR fee, not the dentist’s actual fee.
Downgraded benefits can also effect the amount an insurance company will pay for a filling. Many insurance companies downgrade tooth-colored fillings to a silver amalgam filling fee. While the insurance company allows patients to have tooth-colored fillings, the patient will have to pay the difference between the fee for the tooth-colored filling and the downgraded UCR fee for an amalgam (silver) filling. The percentile benefit is then applied to the amalgam fee.
Our office goes to great lengths to attempt to provide an accurate treatment plan estimate prior to treatment. We try to figure in the effect of UCR and treatment downgrades when figuring our estimates, but it is not always possible to know the exact amount that an insurance company will reimburse.
Our office only offers tooth colored fillings for several reasons.
1. Tooth colored fillings require less removal of and damage to the underlying tooth structure in order to adhere to the tooth.
2. Tooth colored fillings provide a stronger bond to the tooth structure which makes it less likely than an amalgam filling to allow bacteria under the filling.
3. Tooth colored fillings are made of a non-toxic resin material and can actually make the tooth structure stronger.
4. Tooth colored fillings provide an overall aesthetic benefit as they can be blended to match the color of the surrounding tooth structure making their appearance virtually invisible.