AGREEMENT TO USE TOOTH COLORED FILLINGS AND ADDITIONAL COSTS INVOLVEDTooth Colored Fillings Agreement • September 20th, 2018
There are additional costs involved with composite resin fillings, depending on the insurance plan that you have selected. Insurance companies will only pay for composite fillings based on their charge for a comparable amalgam filling. You will be responsible for the difference between our charge for the composite resin filling and the amount paid by your insurance company for the comparable amalgam filling. This is standard procedure accepted by insurance companies, and is a result of your insurance companies’ reimbursements; NOT based on our billing procedures. Therefore, once we process the insurance claim, there usually will be a difference between the amount you paid to us at your visit, and any remaining co-payment as determined by your insurance company. This means that after we receive your claim, YOU MAY STILL RECEIVE A BILL from us, as the co-payment you paid at the office will cover only part of the procedure.
