My Insurance Covers This.... RIGHT?

We get so many questions from our patients regarding their dental benefits that we thought we'd try and outline some of the answers. Here goes:

Why doesn't my insurance cover all the costs for my dental treatment?
Dental insurance isn't really insurance (a payment to cover the cost of a loss) at all. It is actually a money benefit typically provided by an employer to help their employees pay for routine dental treatment. The employer usually buys a plan based on the amount of the benefit and how much the premium costs per month. Most benefit plans are only designed to cover a portion of the total cost.

How does my insurance carrier come up with its allowed payments?
Many carriers refer to their allowed payments as UCR, which stand for usual, customary and reasonable. However, that does not really mean exactly what it seems to mean. UCR is actually a listing of payments for all covered procedures negotiated by your employer and the insurance company. This listing is related to the cost of the premims and where you are located. Your employer has likely selected and allowed payment or UCR payement that corresponds to the premium cost they desire. UCR payments could be more accurately called negotiated payments.

Since the payments are negotiated, does this mean that there is always a balance left for me to pay?
Typically there is always a portion that is not covered by your benefit plan.

These are just a few of the questions we get, I hope these answers helped. If you have any questions about your dental benefits, please give us a call at 880-3131 and we'll help you navigate this very confusing topic.