Blog

As explained in previous blogs, dental insurance varies widely from carrier to carrier, plan to plan and employer to employer.  Two specific trends are emerging that would be well worth your time to investigate if you ever need a new filling or crown to restore a damaged tooth. 

 

 

 

Silver fillings, or amalgam fillings, used to be the material of choice to replace lost tooth structure that was not significant enough to need a crown or cap. We have since developed better materials that are not only more esthetically pleasing since they are tooth colored, but are also more compatible with your natural tooth. Since amalgam fillings contain metal, they expand and contract with fluctuations in temperature that consistently occur within our mouths. This constant flexion eventually leads to microfissures, or cracks, that allow bacteria to get underneath the filling and begins to destroy the tooth again. Unfortunately, we often cannot see this process on an x-ray because the filling material blocks the image. Since we now have a far superior material available for fillings, we use the tooth colored composite resin materials exclusively at Advanced Dental Health. This composite resin can actually be bonded to the remaining enamel of the tooth to prevent future bacteria from seeping underneath the filling where it can cause additional decay.

 

Many dental insurance plans have a little known clause in them that reads something like this: “Posterior composites paid as amalgams.” What this means is that your insurance company has previously determined that if you get a filling on a back tooth, they will only pay what they would have allowed if you had received an amalgam, or silver filling. In other words, they are only willing to pay their share of an inferior material for your dental care.  This costs the insurance company less money and you are then responsible for the difference. We want you to be aware that this is a potential issue before treatment begins as it can make a big difference in your out-of-pocket cost. 

 

Sometimes crowns, or caps, need to be replaced. The crown may not fit as well as we would like which creates potential for decay under the crown or there may already be evidence of decay under an existing crown. It used to be pretty standard that an insurance company would cover the replacement of an existing crown once every 5 years. However, there is a growing trend toward a much longer waiting period for replacement crowns. Although Dr. Holton hopes to never have to replace a crown he has placed, he often needs to replace crowns that were done elsewhere and occasionally has to replace one that he has done as well. We are happy to assist you in your discovery of your insurance coverage by checking on your dental history if possible. We certainly cannot claim to know every patient’s complete dental history and insurance coverage nuances. Ultimately, it is your responsibility to check with your previous dentist and/or insurance company to determine expected coverage amounts and restrictions so you know what your financial responsibility will be before treatment begins.

 

As we find changing trends within the dental insurance industry, we will always attempt to educate our patients so they may be informed consumers. Insurance companies do not inform dental offices when they make changes, so often times we discover changes by trial and error. Our estimates for any dental treatment we recommend for our patients is always what we believe will be owed with the information we currently possess at the time we are giving you the fees. However, if the actual insurance payment is different than we estimate, it remains the patient’s responsibility to pay the full cost of the procedure less any insurance payment we receive. We hope you understand we do our best to be as accurate as possible and our front office team is amazing, however, it is impossible to predict how insurance will pay every time. Please call our office today, if you have questions about your insurance plan.