Understanding Insurance

Understanding Your Insurance

Having dental insurance or a dental benefit plan can make it easier to get the dental care you need. But most dental benefit plans do not cover all dental procedures. Your dental coverage is not based on what you need or what your dentist recommends. It is based on how much your employer pays into the plan.

When deciding on treatment, dental benefits should not be the only thing you consider. Your treatment should be determined by you and your dentist.

How Dental Plans Work

Almost all dental plans are a contract between your employer and an insurance company. Your employer and the insurer agree on the amount your plan pays and what procedures are covered.

Often, you may have a dental care need that is not covered by your plan. Employers generally choose to cover some, but not all, of employees’ dental costs. If you are not satisfied with the coverage provided by your insurance, let your employer know.

The Role of Your Dental Office

Your dentist’s main goal is to help you take good care of your teeth. Many offices will file claims with your dental plan as a service to you. The part of the bill not covered by insurance is your responsibility.

Cost-Control Measures Used by Dental Benefit Plans

Key terms used to describe the features of a dental plan may include the following:

UCR (Usual, Customary, and Reasonable) Charges

UCR charges are the maximum allowable amounts that will be covered by the plan. Although these terms make it sound like a UCR charge is the standard rate for dental care, it is not. The terms “usual”, “customary”, and “reasonable” are misleading for several reasons:

  • Insurance companies can set whatever amount they want for UCR charges. They may not match current actual fees charged by dentists in a given area.
  • A company’s UCR amounts may stay the same for many years. They do not have to keep up with inflation or the costs of dental care.
  • Insurance companies are not required to say how they set their UCR rates. Each company has its own formula.

If your dental bill is higher than the UCR, it does not mean your dentist has charged too much. It could mean your insurance company has not updated its UCR charges. It could also mean that the data used to set the UCR is taken from areas of your state that are different from yours.