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.
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