Friday, December 31, 2010

Will my dental insurance cover the cost of fillings for my cavities?

I have a couple cavities and will be going to the dentist this Monday. I have Tricare as my dental insurance. They cover: diagnostic and preventative services, basic restorative services(fillings) and other surgeries. This is what it says on their site and I just want someone to make this clear for me. Do I have to pay 20% of the cost or is is that only for requests? Resin/Composite Fillings Cost-Share Under the TDP program, basic restorative procedures (fillings) have a cost-share of 20 percent for the member with United Concordia paying the remaining 80 percent when the care is received from a TDP network provider. The most common materials used for fillings are amalgam (silver) and composite resin (tooth-colored). What is Covered? Under the TDP, the covered benefit for posterior (back) fillings is amalgam (silver). If the dentist and member select resin for back teeth fillings, the member must pay the difference between what the silver fillings would have cost and how much the resin costs. Resin fillings are covered for anterior (front) teeth only. For example, a family member needs a filling on a back tooth. The dentist places a silver filling at the allowable reimbursement rate of $100. Under the TDP, United Concordia pays 80 percent or $80 cost-share and the member pays a 20 percent cost or $20 cost-share. If the dentist places a resin filling on a posterior tooth at the member's request and bills $140, United Concordia still pays only $80 (the 80 percent cost-share for a silver filling). The member now pays $60 (the $20 cost for the silver filling and the additional $40 in billed charges).
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Yes you pay 20% unless you get a white filling on a back tooth, if you decide to get a white filling on a back tooth you will have to pay 20% plus the difference in cost between the silver filling and the white filling.
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