Dental insurance benefits are generally purchased by the employer for the employee as a part of the employee’s benefits package. Just as consumers shop for the most affordable car or homeowners insurance, employers shop for the best dental plans within their company’s budget. Like car insurance, dental insurance plans vary in the amount of the deductible as well as the maximum benefits paid per year. Where dental insurance benefits become a little harder to understand is how the benefits are applied and what is excluded.
You have probably heard about something called the “UCR.” Insurance companies UCR stands for the usual, customary, and reasonable. Insurance companies come up with a figure of what they deem to be a customary fee for a procedure. Then the insurance company will pay a percentage of the UCR.
When I get a treatment estimate, why isn’t it always accurate?
When insurance benefits are verified, the insurance company gives the dental office general information, but doesn’t guarantee that it is correct. It is only until the claim is filed can you know for sure what the actual reimbursement will be. Many insurance companies have exclusions that they don’t reveal until the claim is filed.