# Does Ameritas downgrade fillings?

> Yes, on about half of them. As of September 2026, 48.6% of paid posterior composites (D2391–D2394) on Ameritas plans were paid at the amalgam fee — 51 of 105 lines across 10 practices — and 45.6% of crowns were downgraded. 36.7% of Ameritas downgrades carried no downgrade remark, the highest share we measure. Small sample: 183 eligible lines.

_Updated 2026-09-08. Canonical: https://www.kaylie.ai/blog/does-ameritas-downgrade-fillings_

Ameritas downgrades close to half of the posterior composites and crowns we see it pay —
48.6% and 45.6% as of September 2026 — and it is the carrier least likely to say so on the
remittance: 33 of the 90 downgrades we identified, 36.7%, carried no downgrade remark.
Ameritas publishes its rule clearly in its own product document, which makes the gap a
reporting gap rather than a contract surprise. **State the sample size with the rate**:
Ameritas is the smallest carrier in our September table that clears the evidence bar, with
183 eligible paid lines.

## What we measured

| Ameritas | Paid lines | Practices | Stated on the remittance | Silent | Downgraded |
|---|---|---|---|---|---|
| Posterior composite (D2391–D2394) | 105 | 10 | 27 | 24 | **48.6%** |
| Crown | 68 | 10 | 26 | 5 | 45.6% |

A line is one procedure on one claim; these are paid explanation-of-benefits lines pooled
across the practices Kaylie serves, measured on 8 September 2026. Across every
downgrade-eligible code, Ameritas downgraded 90 of 183 paid lines (49.2%), stated 57 and
left 33 silent — meaning the remittance carried no downgrade remark, but the allowed amount
was below the contracted fee for the billed code, or a substitute line was issued.

These are the smallest counts in the table. Ten practices back each row, which is enough to
say the pattern is not one office's experience, and 105 composite lines is not enough to
argue about the decimal. Treat 48.6% as "about half" and 36.7% as "roughly a third of them
arrive unannounced".

## What Ameritas's own policy says

Ameritas states the rule, the example and the office's collection right in three consecutive
sentences:

> "If two or more procedures are considered adequate and appropriate to correct a dental
> condition, payment is based on the charge for the least expensive procedure… For example,
> if you perform a composite on a molar tooth, we'll consider and process the procedure as
> an amalgam. Your office can collect the difference between the MAC fee for the amalgam and
> the MAC fee for the composite."

— *Ameritas Life Insurance Corp — AM 668 (8-25) Product Document*, 2025

Two details in that quote are worth pinning. The scope is a **molar** tooth, not all
posterior teeth. And the patient's exposure is the difference between the two **allowed**
fees — the amalgam allowance against the composite allowance — not the difference between
your full fee and the allowance. That is an unusually precise statement of the arithmetic,
and it is the number to put in the estimate.

The same product document lists Ameritas's downgrade set as: high noble metal allowed as
noble metal; a crown with a veneer on a molar allowed as a crown without a veneer; and
composite on a molar allowed as amalgam. Its retail policy states the general rule the same
way: "Occasionally two or more procedures are considered adequate and appropriate treatment
to correct a certain condition under generally accepted standards of dental care. In this
case, the amount of the Covered Expense will be equal to the charge for the least expensive
procedure." (*Ameritas My Dental Plan — Plan Details*, undated.)

So the tension is not that Ameritas hides the rule. It publishes it. The silence is on the
remittance for the individual claim.

## Why it depends on the plan group

Ameritas's clause, like every carrier's, describes a provision a plan may carry. Measured
across 3,790 employer groups in August 2026, whether a plan downgrades posterior composites
is settled within the group 97.7% of the time against 77.0% at carrier level. With a
carrier at roughly 50%, that difference matters more than anywhere else in the cluster: the
carrier number is genuinely uninformative for a single patient, and the group number is
nearly decisive.

## What to do

- **Check the allowed amount against your contracted fee for the code you billed on every
  Ameritas line.** More than a third of its downgrades are visible nowhere else, and this is
  the carrier where reading remarks alone will cost you the most.
- **Use the two allowed fees when you quote the patient**, exactly as Ameritas describes it:
  the composite allowance minus the amalgam allowance, not your fee minus the allowance.
- **Check the tooth.** Ameritas's published clause names molars. A downgraded premolar
  composite is outside what it publishes.
- **Record the answer against the employer group number.** One settled Ameritas claim from a
  group predicts the rest of that group far better than the carrier rate does.
- **Do not read a paid-in-full-looking line as proof.** On Ameritas the alternate benefit
  can arrive with the composite still shown as the paid procedure, at a lower allowance.

Numbers last refreshed September 2026.