Dental benefit plans are not really insurance in the traditional sense but are designed to provide you with assistance in paying for your dental care. A plan may have limitation on the number office visits, consultations, radiographs (x-rays) and various treatments it will cover.
Understanding the terms; there are many terms in the dental insurance world which can often make choosing and understanding your insurance feel overwhelming, but we are here to help you understand it.
You will often see the terms, usual, customary, and reasonable, also known as UCR plans. These plans may pay what the plan considers a “customary” or “reasonable” fee limit, whichever is less. Often times your explanation of benefits (EOB) may note that the fee your dentist has charged you is higher than the UCR reimbursement levels that the plan offers. However this does not mean you have been overcharged. Often times insurance companies do not keep up to date data in determining a reimbursement level. There are no regulations as to how insurance companies determine reimbursement levels, and companies are not required to disclose how they determine these levels, this unfortunately results in wide fluctuations. On all insurance plans you will see the term annual maximum, your dental plan purchaser (for example your employer) makes the final decision on maximum levels of reimbursement through its contract with the insurance company. Annual maximums are often based on the amount the employer wishes to pay for the dental benefit. Keep in mind that the cost of dental care has increased significantly over the years, but the maximum levels of reimbursement have not changed much in 30 years.
Often times it is misunderstood that dental staff is an expert on dental insurance, we all experience with working with the different levels of insurance but it is up to you as the policy holder to remain educated on your policy and if you do come upon any questions we are always here to help.