Why Insurance Doesn't Cover Composite Fillings

Modern tooth fillings are able to be perfectly matched to the patient’s natural tooth shade, allowing the filling to be almost completely undetectable to the naked eye. While most people will be inclined to choose this option, known clinically as composite fillings, most insurances will unfortunately not cover them. Here’s a breakdown of what composite fillings are, and why most insurance companies do not ensure that they are covered.

What are Composite Fillings?

Composite fillings are made up of a strong resin material that comes in a wide variety of natural tooth shades in order to ensure that they will be virtually invisible once they have been placed inside the tooth.

In order to place a composite filling, the dentist will remove all signs of decay in the tooth. They will then apply an adhesive to the tooth that is known as bonding agent. The bonding agent is light cured, and then the composite material is then packed into the tooth, which is light cured once more to ensure that is is able to completely solidify and bond with the tooth. The dentist will then adjust the bite until comfortable and smooth and polish the composite.

Composite fillings, known commonly as “white” fillings or tooth colored fillings, are an excellent option for individuals who wish to preserve the natural aesthetics of their smile.

Why Aren’t Composite Fillings Covered by Insurance?

There are a few different reasons that can be cited as to why composite fillings are not covered by most insurance plans. The main reason is quite simply that composite fillings are not necessarily a need, they’re more of a want based on aesthetic purposes. In most cases, a cavity can be filled just as well with an amalgam (silver) filling as it can with a composite filling. However, the placement of amalgam filling usually requires more tooth removal than a composite filling. When placing an amalgam filling, indentations are made into the tooth so that the filling is packed into the tooth. When placing a composite filling, just the decayed portion is removed, and then the filling is bonded to the tooth.

Another reason is that amalgam fillings are easy to use, require less technical work on the doctor’s behalf, and the materials are relatively cheap. Thus, the cost of amalgam fillings are significantly lower than the cost of composite fillings. These factors considered, in most case it makes sense for insurance companies to ensure that amalgam fillings are covered at the very minimum. This allows individuals to receive the treatment they need in order to salvage their teeth. For those who wish to opt for the most aesthetically-pleasing option, composite fillings are certainly an option for them, but they may only be partially covered by their insurance, if they are covered at all.

How Do I Know What My Insurance Will Cover?

Every insurance plan is different. If you’re not quite sure what your plan will and will not cover, give your insurance company a call for a full breakdown of your elected benefits. The representative from your insurance company should be able to inform you what your plan does and does not cover. If ensuring that your composite fillings will be covered is important to you, discuss your options for upgrading your insurance plan, if possible.

For more information about composite fillings, give our San Jose dental office a call at (408) 266-6144.