With the rising cost of insurance premiums, many employers struggle with the decision of whether or not to offer dental insurance to their employees.
There are three major categories of procedures to understand; all have different cost-sharing breakdowns:
1.Preventative and Diagnostic Services: This generally includes two cleanings and oral exams per year as well as a set of bitewing x-rays once every 12 months. Your dental insurance plan will typically pay 100% for these procedures and you pay 0%.
2. Basic Restorative Services: This generally includes silver fillings for cavities, tooth extractions, and re-cementing of existing crowns and bridges, among other things. Your dental insurance plan will typically pay 80% for these procedures and you pay 20%.
3. Major restorative services: This generally includes bridges, crowns, partial and complete dentures among other procedures. Your dental insurance plan will typically pay 50% for these procedures and you pay the other half.
In/Out of Network Dentists
Usual, Customary, and Reasonable (URC)
Almost all dental insurance companies use what is called a Usual, Customary, and Reasonable (UCR) fee guide. This means that they set the price that they will allow for every dental procedure that they cover. This is not based on what a dentist charges, but on what the dental insurance company wishes to cover. For example, your dentist may charge $69 for a dental cleaning but your insurance company will only allow $58 because that is the UCR fee that has been set.
If you are on a policy that requires you to go to a participating provider, you should not be charged the difference between these two prices. A contracted dentist generally has an agreement with the insurance company to write off the difference in charges. If the policy allows you to go to a dentist of your choice, check the insurance company’s UCR fee guide against the fees that the dentist charges. You may be required to pay the difference out of pocket; however, you cannot put a price tag on quality dental care.