First, it’s important to understand that dental insurance isn’t really strictly insurance because it doesn’t actually cover the cost of a loss. Dental insurance is more like a monetary benefit provided by your employer to assist in paying for routine dental treatment.
Each employer selects a plan based on the amount of benefits and the monthly premium cost. Most benefit plans are designed to only cover a portion of the total cost.
UCR (Usual, Customary, and Reasonable) describes the maximum amount an insurance company will allow for a particular dental procedure. Unfortunately, some confusion arises because usual, customary, and reasonable doesn’t really mean exactly what you may think it means. UCR is simply a listing of payments associated with covered procedures. There really isn’t a standard formula or method for determining the UCR, and it isn’t related to the fee that our office charges for a particular service.