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Dental Insurance - What is Usual, Customary and Reasonable?

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Updated: September 13, 2007

Question: Dental Insurance - What is Usual, Customary and Reasonable?

Answer:

Almost all dental insurance companies use what is called a "usual, customary and reasonable" (UCR) fee guide. This means that they set their own price that they will allow for every dental procedure that they cover. This is not based on what a dentist actually charges, but what the dental insurance company wishes to cover. For example, your dentist may charge $78 for a dental cleaning, but your insurance company will only allow $58 because that is the UCR fee that they have set.

If you are on a dental insurance policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the dental insurance company to write off the difference in charges. If the policy allows you to go to a dentist of your choice, check the insurance company’s UCR fee guide against the fees that dentist charges. You may be required to pay the difference out of your pocket, however, you cannot put a price tag on quality dental care.

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