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Below, we’ll try to
clarify the sometimes confusing aspects of dental coverage. But first, some
definitions...
What does it all mean?
UCR
-- A widely used method, which may vary from company to company, 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 geographic area.
Reasonable:
A fee which is justifiable considering special circumstances of the particular
care rendered.
Table of Allowances
-- Assigns a specific dollar to each dental procedure.
Pre-determination:
After the treatment plan is decided upon by the patient and the dentist, the
insurance company reports back to your on what portion of the treatment plan
will be covered.
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 you prefer.
Limitations:
Limits the benefits you receive for procedures or the number of times a
procedure will be covered. For instance, most dental insurance will cover your
dental cleanings, but often it limits this coverage to every six months, Dr.
Steve says.
Exclusions:
Denies coverage for certain procedures.
Least Expensive Alternate
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.
How well do you know your
benefits?
Just as important as
having a dental insurance plan, is knowing what coverage it provides you and
your family. Dr. Steve says that knowing the answers to these questions will
take you a long way to being an informed consumer:
1. What types of dental
coverage are offered by your employer or union?
2. Which procedures does
your dental plan limit or exclude? Do certain procedures have waiting periods?
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