How Dental Plans Work

Almost all dental plans are the result of a contract between your employer and an insurance company. The amount your plan pays is agreed upon by your employer with the insurer.

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. Employers generally choose to cover some, but not all, of employees’ dental costs. If you are not satisfied with the coverage provided by your insurance, let your employer know.

Usual and Customary Rates are the amounts that will be covered by the plan. Although these terms make it sounds like a UCR charge is a kind of standard rate for dental care, that is not the case. The terms “usual” and “customary” are misleading for several reasons:

1. UCR charges often do not reflect what dentists “usually” charge in a given area.
2. Insurance companies can set whatever they want for UCR charges- they are not required to match actual fees charged by dentists.
3. A company’s UCR amounts may stay the same for many years- they do not have to keep up with inflation, for example.
4. Insurance companies are not required to say how they set their UCR rates. Each company has its own formula.

Although you may be tempted to decide on your dental care based on what insurance will pay, always remember that your health is the most important thing. As with other choices in life- such as buying medical or auto insurance, or even a home- the least expensive option is not always the best. Be aware of the details in your dental plan but decide about the treatment based on what’s best for your health, not just what may be covered.

*Above information from the American Dental Association