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Your dental plan is designed to share
in your dental care costs. It may not cover the total cost
of your bill. Most plans cover between 50% to 80% of dental
services.
UCR - Usual, Customary and Reasonable
Under a UCR plan, patients are usually allowed to see the
dentist of their choice. These plans pay an established percentage
of the dentist’s fee or pay the plan sponsor’s
“customary” or “reasonable” fee limit,
whichever is less. Although these limits are called “customary,”
they may or may not reflect the fees that area dentists charge.
It may also be noted on your bill the
fee that your dentist has charged you is higher than the reimbursement
levels of UCR. This does not mean your dentist is overcharging
you. For example, the insurance company may not have taken
into account up-to-date, regional data in determining a reimbursement
level.
There is no regulation as to how insurance
companies determine reimbursement levels, resulting in wide
fluctuation. In addition, insurance companies are not required
to disclose how they determine these levels. The language
used in this process may be inconsistent among carriers and
difficult to understand.
Annual Maximums
Your plan purchaser makes the final decision on “maximum
levels” of reimbursement through the contract with the
insurance company.
Even though the cost of dental care has
increased over the years, the maximum levels of insurance
reimbursements have remained the same since the late 1960’s.
Preferred Providers
Your plan may want you to choose your dental care from a list
of their preferred providers. Whether or not you choose your
dental care from this defined group can affect your levels
of reimbursement.
Least Expensive Alternative Treatment
Your dental plan may only allow benefits for the least expensive
treatment for a condition. For example, your dentist may recommend
a crown, but your insurance may only offer reimbursement for
a large filing. As with other choices in life - such as purchasing
medical or automobile insurance, or buying a home - the least
expensive alternative is not always the best option.
Preexisting Conditions
Just like your medical insurance, your dental plan may not
cover conditions that existed before you enrolled in the plan.
Even though your plan may not cover certain conditions, treatment
may still be necessary.
Treatment Exclusions
Your dental plan may not cover certain procedures, or preventative
treatments such as sealants that can save you money later.
This does not mean these treatments are unnecessary. Your
dentist can help you decide what type of treatment is best
for you.
American Dental Association www.ada.org/public/index.asp
Wisconsin Dental Association www.wda.org
Zoom Whitening www.discussdental.com/consumer/default.htm
American Academy of periodontology
www.perio.org/consumer/index.html
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