Wednesday, March 2, 2016

Why does my insurance talk about UCR?

             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.

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Lee T. Brown, DDS

Brown and Kupper, DDS Inc.

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