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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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