What’s the Deal with Dental Insurance and What are Material Downgrades?

Let’s be honest, dental care is expensive. For those whom have the benefit of Dental Insurance its important to understand your plan’s particular coverage.

Unfortunately, dental Insurance is not always as helpful as it should be. There are definite limitations to even the best insurance plans including yearly plan maximums, procedure exclusions, material downgrades and waiting periods.

An example of a Dental Insurance shortfall that’s become more common, is dental insurance not covering the cost of tooth-colored material, Composite Resin, for a filling. Some dental plans will “downgrade” the type of material for fillings to a silver-colored Amalgam filling.

What does this mean for your out-of-pocket expense?

When your insurance company has a downgrade exclusion, the insurance pays the cost they approve for a Amalgam filling, which is less than the cost for a Composite filling. Your insurance company then states that you will be responsible to pay the difference in cost.

Its unclear why material downgrades exist when there are superior dental material choices available. Amalgam fillings often require a larger preparation size in the tooth in order to retain the filling, and the material itself places greater intrinsic stresses on teeth over time. Tooth-colored Composite resin fillings are chemically bonded to teeth and therefore require smaller preparation sizes and expand and contract more similarly to natural teeth.

Filling downgrades are frustrating for both Dental providers and our patients. Dentists, like myself, whom aim to provide the highest standard of care recommend Composite Resins over Amalgam restorations and for those patients with material downgrades, it can mean a greater out-of-pocket expense. The bureaucracy of an insurance agency deciding what they will and won’t pay for is why our dental office provides our own Blossom Plan, so there’s total transparency on benefits and cost.

If you have any questions about your insurance coverage and treatment payment options are at the dentist, I recommend contacting your dentist to ask.