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Why did dental insurance downgrade

Maintaining good dental health is essential for well-being, and part of that includes getting regular dental check-ups and cleanings. Inevitably, at some point in our lives, we may need dental fillings to address cavities or other dental issues. However, the type of filling recommended by your dental provider may not always be the one covered by your dental insurance plan. In some cases, dental insurance downgrade composite fillings to amalgam, even if the composite filling is the better choice for your dental health.

What is a composite filling?

First, let’s define what composite and amalgam fillings are. A composite filling is a tooth-colored filling made of a mixture of plastic and glass materials. It is used to repair small to medium-sized cavities and can be used on both front and back teeth. An amalgam filling, on the other hand, is a silver-colored filling made of a mixture of metals, including silver, tin, and mercury. It is used to repair larger cavities, especially on back teeth.

Composite fillings have many benefits over amalgam fillings. One major advantage is that they blend in with the natural color of your teeth, making them a more aesthetically pleasing choice. Additionally, composite fillings require less of the tooth structure to be removed, preserving more of the tooth’s natural structure. Composite fillings are also less likely to cause cracks or fractures in the tooth, unlike amalgam fillings, which can expand and contract due to temperature changes.

Another advantage of composite fillings is that they do not contain mercury, which is a concern for some people. Amalgam fillings are made up of approximately 50% mercury, which can be toxic if it enters the bloodstream. While the amount of mercury in amalgam fillings is considered safe, some people may prefer to avoid any potential risk and opt for composite fillings instead.

Why does dental insurance downgrade fillings?

Despite the many benefits of composite fillings, dental insurance companies may still prefer amalgam fillings for several reasons. One reason is cost. Composite fillings can be more expensive than amalgam fillings, and insurance companies are always looking for ways to save money. By downgrading a composite filling to an amalgam filling, they can save money on their payouts.

Additionally, insurance companies may have contracts with dental providers that require them to use certain materials. These contracts may favor amalgam fillings over composite fillings, leading to downgrading.

While cost may be valid a reason for insurance companies to prefer amalgam fillings, it is important to note that composite fillings have many benefits over amalgam fillings. It is important to prioritize your dental health and advocate for the type of filling that is best for you.

One way to advocate for your own dental health is to communicate with your dental provider and insurance company. Ask questions about why a certain type of filling is being recommended, and ask about alternative options if you have concerns. Be sure to read your insurance policy carefully and understand what is covered and what is not.

Another way to advocate for your dental health is to prioritize preventative care. Regular dental check-ups and cleanings can help prevent the need for fillings in the first place. By taking care of your teeth and gums, you can minimize the need for dental work and reduce your overall dental costs.

Final thoughts

If you have ever received an unexpected bill from your dental office, there is a good chance your insurance downgraded your procedure. This can be frustrating, as all unexpected expenses are. At our dental office in Tigard, we do our best to anticipate downgrades and be as transparent about your out-of-pocket cost so you won’t be surprised by your bill.

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