What are Downgrades?
Downgrades are determined initially when your employer negotiates with the insurance company your dental plan or policy. You should have received a copy of this information from your human resources department during open enrollment or near your effective date of coverage. You can always contact your insurance company and get an actual patient and insurance portion based on a given service code, which you can find on all treatment plans.
All proposed and patient fees on your treatment plan(s) are estimated amounts. Most insurance companies send the patient an EOB (Explanation of Benefits) after treatment notifying the patient of their portion and what insurance will cover. If you have any questions or concerns regarding your EOB, this is a good time to contact your insurance company for clarity.
When a downgrade from your insurance company is applied to any treatment the insurer is responsible for the portion of the downgrade as well as the patient’s portion.
Below are the most utilized downgraded services.
· Resin Composite Filling - Also known as white fillings; can sometimes be downgraded to an Amalgam Filling, known as silver fillings.
· Periodontal Maintenance Procedures – Which follow the completion of periodontal scale and root planning can sometimes be downgraded to a regular Adult Prophylaxis.
All downgrades are at the discretion of your insurance company and the policy or plan your employer has agreed to.
We at Unique Dental Care, advise our patients after receiving a treatment plan to contact their insurance company to get a clear understanding of the patient’s payable amount for service and the insurance company’s responsibility for that treatment.
Unique Dental Care, PLLC
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