Insurance Downgrade Work Around

This Financial Coordinator resource provides instructions that will save you time during insurance submissions and multiple bills to patients.

Insurance Downgrade Work Around

  • About 80% of the time, insurance downgrades posterior fillings to amalgam fillings. Even if they tell us that posterior composites are covered at 80%, this is rarely the case.

  • Unfortunately, we then get paid less than the estimated amounts and patients get upset with us when they receive a bill even though we have made them aware that our estimate is just that, and not a guarantee.

  • To avoid having to send a bill after the payment from insurance is paid, we are going to “cheat the software” to  get a more realistic estimate for the patient of what we expect the insurance to pay.

View the complete document and print out a copy for your office below!
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