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Understanding UCR

UCR is a widely used method, which varies from one insurance company to another, for determining benefit reimbursement levels. The initials simply mean:

Usual: The fee that an individual dentist most frequently charges for a given dental service.

Customary: A fee determined by the insurance company based on the range of usual fees charged by dentists in the same geographical area.

Reasonable: A fee which is justifiable considering special circumstances of the particular care rendered.

Other terms used by insurance carriers include:

Pre-determination: After the treatment plan is decided upon by the patient and the dentist, the insurance company reports back on what portion of the treatment plan will be covered by your insurance policy.

Table of Allowances: Assigns a specific dollar to each dental procedure.

Freedom of Choice: Allows the patient to choose any dentist. Coverage with this feature allows you to receive full benefits for treatment provided by any dentist of your choice.

Limitations: Limits the benefits for procedures or the number of times a procedure will be covered.

Exclusions: Denies benefit coverage for certain procedures.

Least Expensive Alternative Treatment: The insurance company's contractual arrangement with the policyholder allows the insurance company to substitute a less expensive, but in the insurance company's opinion, professionally adequate service.

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