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Understanding Coverage for Fillings
There are two common types of dental filling materials – amalgam (silver-colored) and composite resin (tooth-colored). When you and your dentist are determining which filling material is best for you, it’s important to understand how your decision will impact your out-of-pocket costs.
Under the United Concordia FEDVIP, coverage is provided for composite resin fillings for the anterior (front) teeth, but not for the posterior (back teeth). The covered benefit for posterior fillings is an amalgam filling. If you select the composite resin filling for your back teeth, you must pay the difference in cost above the charge for the comparable amalgam restoration.
Example 1: You or your family member needs a filling on a posterior tooth. You and your dentist decide to use an amalgam filling at the allowable reimbursement rate of $100. Under the FEDVIP, United Concordia pays 80 percent ($80) and you pay 20 percent ($20).
Example 2: If you and your dentist decide to choose a composite resin filling on a back tooth, and the dentist charges $140 for that service, United Concordia would still pay $80 (80 percent of the cost of the comparable amalgam filling). Your out-of-pocket cost would now increase to $60 (20 percent of the cost of the comparable amalgam plus the remaining difference of $40).
If a proposed treatment plan costs $200 or more, United Concordia encourages you to ask for a predetermination. Your dentist will submit the information to United Concordia and you will receive a breakdown of how much the plan covers and how much you will have to pay, helping you make the most from your dental plan.
Other Benefits Briefs
Understanding Coordination of Benefits
About United Concordia’s Network
Understanding Alternate Benefit Provision
We also have a library of Dental Health 101 articles for you and your employees’ information. Please feel free to use these in your publications/communications as well.
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