There are many types of medical and dental health insurance plans that patients might seek. This information will be discussed in multiple sections.
UCR – Usual, Reasonable & Customary Fees with a Medical or Dental Health Insurance Plan.
This term is intentionally misleading by the insurance industry. It is common to see on a patient’s dental insurance plan Explanation of Benefits (EOB) that accompanies the dental reimbursement check a statement saying “The fee charged exceeds the Usual, Reasonable & Customary Fee.” This is misleading because there is no such thing as a UCR fee! The UCR varies, within the same insurance company, proportionally to the amount of insurance premium paid.
For example, Aetna may pay $200 for one patient’s dental cleaning but $150 for another patient’s dental cleaning at the same office if they have a different dental insurance plan from different employers. The “UCR” rate is determined by the amount of premium paid.
The amount of reimbursement an insurance company will pay for any dental procedure is determined by the premiums paid by the patient and/or employer. But insurance companies don’t want to say that since they get their business from employers who buy their insurance. It is this gracious deference to employers that makes insurance companies want to avoid the suggestion that a reimbursement is low because the employer has cheap coverage. Instead they give the appearance that the coverage is low because the dentist is too expensive. It should be illegal.
–Dr. Jeffrey Dorfman, Director
The Center for Special Dentistry
The Center For Special Dentistry is NOT a member of any dental insurance plan network.