Dental insurance plans vary greatly from company to company as well as from dental plan to dental plan within a single company, and use specialized terms that are difficult for most of us to understand. As such, it is extremely important for you to understand exactly what is covered and how your plan pays for your dental treatment.
Question: How do insurance plans determine payment?
Answer: Most dental insurance plans utilize either a Table of Allowances or the UCR method. A Table of Allowances lists the treatments the insurance provider will pay and the amount it pays for each treatment or service. With the UCR method, the insurance provider calculates the maximum payments that it considers usual, customary, and reasonable for allowable treatments, and then pays, depending on the plan, 50 to 80% of that amount. The insured individual is then responsible for paying the remaining 20 to 50% of the UCR fees PLUS the difference between the actual cost of the treatment and the plan’s allowable UCR fees.
Question: Payment methods are based on statistics, aren’t they?
Answer: It is certainly a reasonable assumption to make; however, though statistics may be gathered, insurance companies are not required to use them to set their UCR fees. In fact, most insurance plans’ fees are not ordinarily representative of what your area dentists actually charge.
Additionally, different dental plans within a single company often base their fees on a different set of UCR fees for the very same group of dentists in your geographical area. A dental insurance company often pays different UCR fees to the same dental office, depending on which of that company’s insurance plans the individual has enrolled in.
Dental insurance plans have not kept abreast of technological advances or of inflation since the 1960’s. All of these factors combine to make many patients choose a treatment plan that is not fully covered by their dental insurance.
Even though most dental insurance plans only cover basic services, it is important to choose the best dental treatment plan that is most appropriate for you and your loved ones. Our office also has several financial options available to help you afford the best possible treatment. If you have any questions, please call your insurance provider to learn exactly what they cover. If we can be of help, please give us a call or use our Contact Us Form.
Chuck Campbell, DDS
Dale Brant, DDS
(713) 795-5905
