If you have dental
insurance, then you have likely seen the phrase ‘Usual and Customary Rate’
(UCR). A dental insurance company will love to use this term, but what does it
mean for you? Who determines this number? We want to help you understand where
these numbers are derived and how it is applicable to you.
In reality, there isn’t a ‘usual, customary, or
reasonable fee.’ This is a phrase that created by insurance companies to impose
their will on dentistry. There isn’t a specific number that insurance has
arrived upon, but instead a range of fees based upon percentiles. Even if an
insurance carrier was capable of tracking every dental office’s fees, then
arrange them into proper zip codes, it is impossible to place a value of the
types of materials or the amount of time given to a particular procedure. Assigning
a UCR to a dental procedure is like assigning a UCR for a cheeseburger. It
doesn’t account for the difference between fast food restaurants versus a high
end restaurant. There is no consideration for the ingredients, the service, the
quality of preparation, and the execution.
Another issue frequently encountered involves the
percentage of coverage your insurance allows for a given procedure. Again, the insurance companies determine their own
definition of which fee percentile a procedure may fall into through their
own independent research. After the percentage is determined, an employer is
offered different options of which fee percentile to purchase for their benefit
package. They may only buy up to the 50th percentile, and then your
out of pocket costs may increase. Even with fees increasing over time with
inflation, it is possible that additional expenses may be incurred if your
dental insurance has been adjusted to cover a lower percentile.
Dental insurance is unique from medical insurance and can
be very confusing. There are also a lot of differing individual circumstances. Please
call us with any questions regarding your current insurance or if you’re ever
picking a new policy through your employer. Hopefully we can help you sort
through some of the pros and cons of each policy.
For more information, visit www.dentistwestchester.com.
Lee T. Brown, DDS
Brown and Kupper, DDS Inc.
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