For anyone that has dental insurance, chances are you have seen or are familiar with the phrase Usual and Customary Rate (UCR). Dental insurance companies like to use this term, but what does it mean for the average person and how was this number determined? Our goal is to help you better understand where these numbers come from and how it is applicable to you.
The reality is there is no such thing as a ‘usual, customary, or reasonable fee.’ This is a hoax that has been created by the insurance companies to impose on dentistry. There is no single number that insurance has arrived upon, rather a range of fees based upon percentiles. Even if an insurance carrier found a way to track every single dentist’s fees in every single zip code, there is no way to place a value of the types of materials or the amount of time given to each procedure. Trying to assign a UCR to a dental procedure would be like assigning a UCR for a cheeseburger whether it is from a fast food restaurant or a high end restaurant. It doesn’t take into account the ingredients, the service, or the quality of preparation and execution.
The other issue frequently encountered involves the percentage level of coverage your insurance allows. Again, the insurance companies determine their own definition of which fee percentile a procedure may fall into through their own independent research. After the percentages are determined, your employer is offered different options of which fee percentile to purchase. They may choose to only buy up to the 50th percentile, and thus your out of pocket costs at each visit may go up. Even though some fees may increase over time due to inflation, it is possible additional expense may be incurred if your dental insurance has been adjusted to cover a lower percentile.
Dental insurance can be very confusing and there are always a lot of differing individual circumstances. We encourage you to call us with any questions you have regarding your current insurance or if you’re ever in the process of picking a new policy through your employer. Hopefully we can help you sort through some of the lingo.
For more information, visit www.brownandkupper.com.
Lee T. Brown, DDS
Brown and Kupper, DDS Inc.