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Insurance companies may also limit their payment by the use of UCR fees. The insurance company select a UCR fee for each procedure and at what percentage the procedure will be reimbursed. For example, a plan with a high premium may have a higher UCR. If a plan has a lower premium the insurance company may set the UCR lower. Your plan booklet may say that they reimburse at 75%, but it is 75% of a number chosen by the insurance company. If an employer wants a plan with lower premiums then by lowering the UCR insurance companies can reduce the cost of the premium to the employer. If the UCR is lower this can increase the patient's out of pocket expenses. (We often see a variety of UCR's from the same insurance companies for different employers.) If a fee exceeds the UCR chosen by the insurance company, they will tell you "The fee charged exceeds the usual, customary and reasonable fee charged in your area". This is not necessarily the case, it may be more accurate to say, "The employer chose a plan that does not reimburse at the level charged by most dentists in the area."
Your benefits are decided between your employer and the insurance company. Many needed services may not be covered. Our office will do everything possible to help you understand and make the most of your dental insurance benefits. Please remember that you are ultimately responsible for all expenses incurred. We urge you to read the policy so that you are fully aware of coverage and any limitations of the benefits provided.
We hope you found this information useful. Insurance matters are often complicated, so if you have any questions regarding your coverage, please feel free to talk to our insurance coordinator.
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