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My dentist recommended this treatment. Why doesn’t my Insurance cover it fully?

Your dental plan may only allow benefits for the least expensive treatment. For example, you have a tooth that is fractured and cannot be restored. In this case, your dentist may recommend an implant and a crown. Your insurance may only cover a bridge. Or your insurance may only be willing to cover an amalgam (silver-colored)filling. If you choose to have the amalgam filling, then your insurance would cover it fully and you would not have any out-of-pocket expenses. However, you will have a very noticeable silver filling and most likely will opt to have it re-done in the future for cosmetic and health reasons. Not to mention, that it is a temporary fix for a tooth that has a huge fracture. Most likely the filling will not hold very long due to the trauma to the tooth and you will end up having an implant and a crown done down the road anyways. If you choose to have your insurance cover the bridge, then you have to use two perfectly healthy teeth that neighbor the fractured tooth to support it. Overtime, this can cause stress on the neighboring healthy teeth and potentially lead to more dental work down the road. If you choose the implant and crown your insurance may cover a portion of the cost, which leads you with more out-of-pocket costs at this time, but potentially will save you from costly procedures down the road. Ultimately, the dentist recommends a treatment that is best for the patient overall. The insurance recommends a treatment that is less expensive for the insurance company and mainly benefits the insurance company. And the patient is left with the decision of which path to choose. It is very frustrating both for the patient and the health care team because often cost is a deciding factor for treatment. But, it is important to remember long-term costs as well in deciding treatment plans with your dentist.