Why Doesn’t My Insurance Pay for this?
Having dental insurance or a dental benefit plan can make it easier to get the dental care you need. But most dental benefit plans do not cover 100% of all dental procedures.
Your dental coverage is not based on what you need or what your dentist recommends. It is based on how much your employer pays into the plan.
When deciding on treatment, dental benefits should not be the only things you consider. Your treatment should be determined by you and your dentist.
For example, many plans have restrictions on frequency of treatment or cleanings. Most plans cover two cleanings a year. However, many patients need more frequent cleanings to maintain healthy teeth and gums. Every person builds up tarter and stain at different rates. Some people have gum or periodontal disease, which requires extra attention. Others have healthy gums and have never had a cavity. Therefore, it does not make sense that every person would need the same amount of time between cleanings. Insurance companies do not take into account your dental health or needs when determining your coverage.
“Usual, Customary, and Reasonable”
These are terms to describe charges that are the maximum allowable amounts that will be covered by any given insurance plan. These terms make it sound like a “UCR” charge is the standard rate for dental care, but it is not. These terms are misleading for several reasons:
- Insurance companies can set whatever amount they want for UCR charges. They often do not match current actual fees charged by dentists in a given area.
- A company’s UCR amounts often stay the same for many years. They do not have to keep up with inflation or the costs of dental care.
- Insurance companies are not required to disclose how they set their UCR rates. Each company has its own formula which does not take into account the quality or cost for different materials.
If your dental bill is higher than the UCR it could mean your insurance company has not updated its UCR charges or that the data used to set the UCR is taken from areas of your state that are different from yours.
Adams and Cheek Dentistry’s Role
Our main priority is always to help you take the best care possible of your teeth. We file claims to all dental insurance companies. What your dental insurance company covers depends on your provider and your specific benefits plan. The part of the bill not covered by insurance is your responsibility. If you have any questions, please call Adams and Cheek Dentistry at (919) 866-1360 or visit our patient information page.