Why Doesn’t My Dental Insurance Pay for This?

What are UCR (usual, customary, and reasonable) charges?

UCR charges are the maximum allowable amounts that a particular insurance plan will cover. Even though it sounds like the standard rate for dental care, it is not. The insurance companies can set whatever amount they want for the UCR charges and it may stay the same amount for many years despite inflation. The important thing to remember is if your dental bill is higher than the UCR, it doesn’t mean your dentist has charged too much!

Annual Maximums

This is the largest number your dental plan will pay during the year. It is important to remember that it is your employer that decides the maximum levels of payment in its contract with the insurance company. After you have reached the maximum, you are responsible to pay any costs above and beyond that number. Unfortunately, many maximums have stayed the same despite inflation and rising costs.

Coordination of Benefits or Non-duplication of Benefits

This applies to people with more than one dental plan. But even though you have two or more benefit plans, there is still no guarantee all of the plans will pay for your services. In fact, there are times when none of the plans will pay for what is recommended. Be sure to check each plan for details.

Plan Frequency Limitations

Some dental plans will limit how many times they will pay for a certain treatment. For example, your insurance may only pay for 2 professional cleanings per year. However, there may be times where 3 or 4 cleanings are recommended to maintain good oral health. We recommend making your decisions based on what is best for your health, not just what is covered.

Not Dentally Necessary

Some plans may state they will only cover procedures they feel are medically or dentally necessary. But just because your insurance company doesn’t see the value, doesn’t mean the treatment is not necessary.

While we certainly understand the value of dental insurance, we will continue to make our diagnosis and treatment plans in accordance with what we believe is best for your dental health.