A note on dental insurance.
There is a lot of confusion about how dental insurance providers deal with white (composite) fillings. As you know, the old style of restorations are silver (amalgam) fillings. Most dentists now use composite restorations exclusively. (For a full discussion of amalgam vs. composite restorations please see previous blog posts on this site or go to www.ada.org.) Dental insurance providers deal with composite restorations in different ways.
Most insurance providers will pay for white restorations on the six front teeth (canine to canine or I-tooth to I-tooth). Whether or not an insurance company pays for white restorations on back teeth depends on the patient's insurance plan. Some plans pay a percentage of the fee for white restorations on back teeth. These are great plans. The patient's co-pay should not be very much. Some plans "downgrade" to a silver filling fee. These plans pay only a percentage of the fee they would have paid for an old amalgam (silver) restoration. The patient's co-pay would be much higher but they would still get some benefit. Other plans pay nothing at all. If a patient has a composite filling the insurance company will pay $0 to the dentist. These are very bad plans. There are very few dentist who actually still use silver, and the patient is responsible for a large co-pay.
How do we establish the co-pay at the time of the visit? We ask an insurance company representative over the phone what type of coverage the patient has and what the co-pay should be. The insurance company tells us the co-pay based on the plan purchased by the patient. Even though the co-pay comes from the patient's insurance company, they underestimate the co-pay about 25% of the time. If this is the case, the patient is responsible for the additional co-pay.