Being enrolled in a dental plan, doesn’t mean that whenever you need dental treatment, everything is already payed for. They will only pay for a portion of the cost. But still, having dental care coverage is very helpful. If you don’t have coverage like some people, you will have to shoulder 100% of the dental fees. How much the insurance will cover depends on the policy you have. A lot of insurers will make you believe that if you have a dental insurance, you’ll be covered from 80% – 100% of the cost. In reality however, your coverage only ranges from 20% – 70% at the most. However little your coverage may be, having dental insurance is still very important. If you’re under an employer-sponsored dental insurance, your employer most probably chose a policy which is cost-effective on their part. And the cheaper the policy, the less benefits included. But you’ll never hear this from them.
What’s hard about understanding the covered costs is that there are fine prints. Example, they’ll say that coverage for filling will be $84 and you find out what they will actually pay for is only $40. This is because of what they call “UCR fee” – usual,customary and reasonable fee. How is UCR calculated? The insurer surveys on what is the customary fee for a filling from among dentists in the area. If their usual fee for a filling is only $40 then they decide that they will only pay for $40 for filling services. So it becomes a problem when your dentist charges much more than this. You’ll have to cover the difference.
The UCR fees in your policy depends on the premium that your employer is paying for. Just like in other kinds of insurance. The lower the premium, the less benefits are included. Some dental procedures may not be covered. It is not good for you to fit your dental needs into the mold of the insurance coverage. But rather find an insurance that fits your dental health requirements.
