Can dental fillings be covered by health insurance and what is the procedure? Nowadays, with the increasing prevalence of oral health issues, dental clinics have been rapidly developing and investing in modern equipment to meet the needs of customers.
As a result, the costs of dental services have also increased. Using insurance as a necessary means to reduce the financial burden of dental treatments is a common practice.
However, most of us typically use health insurance to cover medical treatments at hospitals. So, does health insurance apply to the dental field? Can dental fillings be covered by health insurance? What is the procedure? Let’s find out with BeDental in this article!
What is health insurance and its benefits?
Health insurance is a type of insurance mandated by the government for individuals specified by the Health Insurance Law.
Its purpose is to provide financial support for partially or fully covering medical expenses and reducing the financial burden on patients when receiving medical examinations, treatments, and medications at hospitals and healthcare facilities, contributing to improving the quality of life and social well-being of the nation, rather than pursuing any profit motive.
Currently, the cost of medical treatments at hospitals and healthcare facilities is quite expensive. Therefore, using health insurance can help partially cover these costs and reduce the financial burden when receiving dental treatments.
Additionally, health insurance can be widely applied not only at public hospitals but also at private ones.
This allows you to choose the most suitable healthcare facility near you for treatment. As a result, you can access the best dental services and medications, as well as modern and safe healthcare facilities.
How much does dental filling cost and what factors does it depend on?
The cost of dental fillings can vary in different regions and healthcare facilities. However, the average price for dental filling is around 300,000 VND per tooth. The cost of dental fillings can fluctuate depending on several factors:
The condition of your teeth
Based on the condition of your oral health, the dentist will develop different treatment plans, and the cost of dental fillings can vary accordingly.
For cases where your teeth have minor cracks, fractures, or cavities, the cost of dental fillings is not heavily dependent on the condition of your teeth but rather on the number of teeth to be filled and the filling material used.
For teeth with severe cavities or infections, additional treatments for those conditions may be required. Therefore, the cost of dental fillings can be higher depending on the specific situation.
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Materials used for dental fillings
Dental fillings can use different materials depending on each case and the patient’s desired outcome. Each material has its own advantages and disadvantages and has been improved over time to enhance quality. Therefore, the cost for each dental filling material varies.
Currently, dental clinics often use materials such as Composite or porcelain. These materials are known for their higher aesthetic appeal and better tooth coverage, so they usually have higher costs compared to older materials like Amalgam.
Number of teeth to be filled
The number of teeth that need filling is also a determining factor in the cost of dental fillings. The more teeth that need filling, the higher the cost.
Type of dental filling
Dental fillings can be done through two methods: direct filling and indirect filling. For direct filling, specialized dental materials are used to directly fill the cavities, providing quick and effective results.
On the other hand, the indirect filling method, specifically Inlay-Onlay, involves creating a customized filling outside of the tooth and then fitting it into the prepared area. This method is typically used for larger cavities or extensive tooth damage.
To perform this method, the dentist will take an impression of the tooth that needs filling, and then design and shape the filling to fit the missing part of the tooth. This method requires high technical skills and the use of high-quality materials (such as pure porcelain), thus resulting in higher costs for dental fillings.
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Can dental fillings be covered by health insurance?
Dental fillings are a dental service where, if you have issues with your teeth such as cavities, cracks, or fractures, the dentist will use specialized dental materials to restore the shape of your teeth and restore their chewing function.
However, dental fillings at dental clinics can be quite expensive. So, can dental fillings be covered by health insurance?
According to Article 21 of the Health Insurance Law, dental fillings are one of the dental services that can be covered by health insurance when receiving medical treatment. However, you will be eligible for reimbursement from health insurance for dental fillings in the following cases:
- If your teeth have dental diseases that require dental fillings or if the dental filling is prescribed by a dentist.
- If the treatment cost is not covered by the state budget.
To put it more clearly, when your teeth have dental issues such as cracks, cavities, or certain diseases caused by the body, if you receive dental fillings at healthcare facilities or dental clinics covered by health insurance, you will be reimbursed partially or fully for the treatment cost.
However, cases where you want dental fillings for cosmetic or personal preference reasons will not be eligible for these health insurance benefits.
Can dental fillings be covered by health insurance?
Similar to dental fillings, dental examinations are also within the scope of coverage from insurance.
According to Article 21 of the Health Insurance Law, when patients come for examination and treatment at healthcare facilities, hospitals within the insurance coverage, they will be eligible for partial or full reimbursement for the cost of the examination and medication. However, for regular health check-ups, you will not be eligible for this insurance benefit.
How much percentage of the dental filling cost can be covered by health insurance?
It can be seen that health insurance can be applied in many different areas of medical treatment, including dentistry. As long as you can meet the regulations set by the Insurance Law, you can apply health insurance to reduce the large expense of treating your health issues.
The percentage of reimbursement from insurance is clearly defined for each specific case, taking into account the severity of the condition and where the treatment is performed.
Specifically for dental fillings covered by health insurance, if you get dental fillings due to dental diseases like cavities, cracks, fractures, or other body diseases that require filling as prescribed by the dentist, you will be eligible for reimbursement ranging from 40% to 100% of the cost(depending on the severity of the condition and the location of the treatment).
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In the case of dental fillings at registered healthcare facilities within the insurance coverage, you will be eligible for reimbursement from insurance at a rate of 80-100% according to the specified categories in Article 3, Clause 12 of the Supplementary Health Insurance Law 2014.
In the case of treatment at out-of-network or referral facilities, you will be eligible for reimbursement ranging from 40-70% of the treatment cost from insurance. Typically, provincial or central facilities are applicable for reimbursement.
How long does dental filling covered by health insurance last?
Based on the materials used by dental clinics nowadays, dental fillings typically have an average lifespan of 5-7 years. In some cases, fillings can last longer, even up to 20 years. Therefore, the lifespan of a dental filling depends on the following factors:
- Oral hygiene habits: Proper oral hygiene habits help eliminate bacteria and prevent tooth decay, ensuring the cleanliness of the filling and oral cavity. If not properly maintained, dental fillings can contribute to the formation of new cavities, especially around the filling, leading to a shorter lifespan with increased risks of chipping and deterioration.
- Location of the filling: The pressure from chewing affects the lifespan of dental fillings. Therefore, fillings placed in primary chewing positions often endure more pressure and are more prone to wear and early failure compared to other areas.
- Teeth grinding: Teeth grinding is a harmful habit for your teeth. It often occurs during sleep, while driving, or when stressed. This unintentionally adds pressure to dental fillings, leading to the development of cracks around the filling and potential damage to the filling.
- Eating habits: Foods that are high in acid, sugar, or carbohydrates, typically found in snacks, soft drinks, alcohol, coffee, etc., can create an environment for bacteria to thrive around dental fillings, increasing the risk of damage to the fillings.
Can insurance be claimed when changing from metal fillings to other types of fillings?
In the case that your old filling is leaking or new cavities have appeared, and you need to replace the old filling before it becomes more severe or as recommended by your dentist, health insurance can be applied as the replacement of your dental filling is due to dental diseases according to the regulations of health insurance.
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However, if you want to replace your filling solely for cosmetic purposes, it is likely that you will not be eligible for insurance coverage. The conditions for health insurance coverage are still quite general and not specific to individual cases.
Therefore, when undergoing any dental service that you want to use health insurance for, it is important to research and ask your questions and concerns to ensure that you can fully benefit from insurance coverage.
What is the procedure for using health insurance for dental fillings and dental treatment?
Currently, for dental clinics that do not have social insurance policies, patients can still use health insurance for dental fillings and other services, but it is combined within the health insurance group.
Therefore, for health insurance, it is usually applied at state-owned hospitals or public institutions at the same or different levels of registration. The application of health insurance is carried out according to a procedural sequence similar to other normal treatments and medical examinations. The process is as follows:
Step 1: Take a queue number and fill in the registration form. For first-time patients, they need to fill in the registration form. For subsequent visits, they only need to take a queue number at the counter.
Step 2: Receive the dental examination with health insurance.
Step 3: Undergo the dental examination at the designated specialist clinic.
Step 4: Pay the costs according to the benefits of health insurance.
Step 5: Undergo necessary diagnostic tests and wait for the results as indicated in the appointment slip.
Step 6: Enter the diagnostic room, listen to the explanation of the dental condition, issues, and receive the treatment plan for dental fillings.
Step 7: Go to the pharmacy to collect medications covered by health insurance (if applicable), pay for the medication costs, and self-pay for any medication costs that are not covered by health insurance.
When using health insurance for dental examinations and fillings, there are certain procedures that need to be followed. Therefore, you need to bring along personal identification documents such as your ID card or citizen ID, driver’s license, and health insurance card.
These documents will be requested by the medical staff during the procedure. For children under 6 years old, only the health insurance card needs to be presented.
Health insurance can be applied to various health issues, helping to alleviate the financial burden of treatment. Specifically, dental fillings will no longer be a concern when it comes to costs if you apply health insurance for treatment.
However, it is important to thoroughly understand whether your specific issue can be covered by health insurance, as well as the necessary procedures and documents required before undergoing the examination, in order to ensure that you can fully benefit from your health insurance coverage.
Please leave your contact information if you would like further dental advice.
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