The Dentist Richard Luczak, DDS, MPH

Insurance? What I need to know.

Published on March 7, 2012 by

There’s some confusion regarding dental insurance. I’m often asked, “Why doesn’t my insurance cover more?” and “Why does the insurance say the dentist’s fees aren”t UCR?” Dental insurance carriers offer a cafeteria style menu of coverage options to most employers. Whenever employers choose a plan, the employer considers the level of customer service; timely processing of claims; & finally the COST.¬† Employers can also decide what will and will not be covered, based on COST. ¬†Often this decision results in the patient (YOU) paying more out of pocket than expected.

UCR, “Usual, Customary, & Reasonable” is the ceiling amount an individual¬†insurance carrier will pay towards any procedure. This fee is typically based on a range of fees dentists charge in a certain geographic area. If an employer selects a plan with a cheaper premium/coverage, then the plan will pay less towards treatment. The insurance carrier’s statement or EOB (Explanation of Benefits) will state the dentists fees are more than the UCR. The UCR is not a reflection of whether or not the dentist’s fees are reasonable, it’s a reflection of an amount & type of coverage purchased by the employer.

So, think of dental insurance as a way to help reduce the cost of treatment; not a way to eliminate the cost entirely.

Filed under: Financial

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