If you are like most people, you probably don’t pay much attention to your dental benefit plan. The book outlining the details of your plan can be cumbersome and difficult to understand. Here are a few things you need to know about a dental plan.
A dental plan is a contract between your employer and the insurance company to pay a predetermined portion of your dental care. Some plans outline what dental services your employer has agreed to pay and which dentists you can see.
It is important to read and understand your benefit plan summary. Keep in mind, your insurance plan might not adequately provide for all of your dental treatment needs. Only you and your dentist can decide what treatment is best for you.
How are my dentists’ fees determined?
Your dentist determines a fee for each procedure performed. These fees frequently vary between dental offices due to varying overhead costs. Factors affecting the differing fees include: staff costs, office location expenses, state-of-the-art equipment, modern dental materials, current infection control measures, and continuing education to ensure that the dental team is up to date on the latest techniques.
How are my dental benefits determined?
Your benefits are determined by the contract your employer has set up with the insurance company. Your employer pays the insurance company a specific premium; the insurance company uses the monies collected to pay for your care. Usually, the higher the premium your employer pays, the better the coverage and the less you will be expected to pay out of your pocket.
When you are looking at the description of your dental plan, check carefully to see which services will be fully covered by your insurance and which ones will require you to pay a portion, often a percentage, of the “usual, customary, and reasonable fee.”
Most insurance companies use a “usually, customary and reasonable” (UCR) fee schedule to decide what portion of the fee they will pay for. This UCR fee is a predetermined fee and varies greatly among the different insurance companies. In addition, be aware that these fees are often negotiated between your employer’s plan administrator and the insurance company. Because the insurance company sets the fee limits, they may or may not reflect the actual costs of dental care in your area. There are no standards for determining UCR fees. So the percentage of the fee you pay will vary depending on the difference between your dentist’s fees and the UCR.