If your employer offers dental insurance, consider yourself fortunate. This benefit works like a valuable “coupon” that can reduce your dental care costs. However, no dental plan is set up to cover all of your costs.
Almost all dental plans are a result of a contract between your employer and an insurance company. The amount your plan covers is agreed upon by your employer with the insurer. Your dental coverage is not based on what you need or what your dentist recommends. It is based on how much your employer pays for the plan.
Your dentists main goal is to help you take good care of your teeth and gums. Although you may be tempted to decide on your dental care based on what your insurance will pay, always remember your health is the most important thing. As with other choices in life – such as buying auto insurance or a home, the least expensive option is usually not the best.
What does UCR mean?
Usual, customary and reasonable (UCR) are the maximum amounts that your plan will cover. Although this term sounds like a standard rate for dental charges, that is not the case. UCR charges very seldom reflect what the usual charges are in a given area. Insurance companies can set whatever they want for their UCR charges and they are not required to match any actual fees in your area. An insurance companies UCR amounts can stay the same for many years and do not even keep up with inflation. They are not required to say how they set their rates and each company has its own formula.
A dental plan may limit the times they will pay for a certain treatment, even though some patients may need treatment more often for their oral health. Fo example, most plans will cover two cleanings and check-ups a year, even though the patient needs four cleanings a year. Be aware of the details of your plan, but please decide about treatment based on whats best for your health and not on what insurance will cover.