A dental fee schedule is a list of prices that discloses how much your dentist charges for specific treatments/services, and what your dental insurance plan will pay for. These two amounts are not always the same. For instance, a dentist in one part of the town may have higher prices, but the insurance carrier over a large region or state may only “allow” a set fee that is less than the actual charge.
While all of this can sound a little confusing, it’s your dental treatment coordinator’s job to explain how the two work together when estimating the overall cost of your oral care.
“Usual, Customary, and Reasonable”
Most likely, your dental insurance carrier bases their fee schedule off of something that they call “UCR fees,” or, “Usual, Customary, and Reasonable.” As you might expect, the costs are adjusted depending on what’s expected for that area.
A number of factors may need to be considered, such as:
- Cost of living, to calculate the dentist’s cost of offering a service
- What the average price is at other dental offices in the area
- Materials used, such as metal, ceramic, or gold
- Laboratory fees
- The number of appointments needed
- The type of treatment category that the procedure falls into
The reasonable rate is the fee charged by the dentist, but the customary amounts are dictated by the dental insurance company. If the two don’t correlate well together, it could leave your dental insurance policy falling short of paying for the treatment that you need.
Finding an In-Network Dentist
Depending on the type of insurance plan you have, and which office you’re visiting, your dentist may have a signed contract in place that says they have to bill patients based off of the insurance’s fee schedule.
The problem here, is that many insurance fee schedules are set so low, dentists can have a hard time earning a profit. So, they decide not to become a preferred provider and your choice of in-network dentists gets smaller and smaller.
But, if your dentist is in-network, or you’re using a program such as a dental savings plan that is accepted, you can know exactly what to expect when it comes to paying for your treatment.
Different Categories of Treatments Make a Difference
Your dental insurance fee schedule is based on the “type” of treatment category that a particular procedure falls under. For instance, one category of services might be covered at 50%, while another type of service is covered at 80%. So, if the fee schedule allows for a charge of $100, you may pay $20 or $50 (plus any deductibles) depending on the specific type of treatment that you’re getting.
Here are a few examples of how treatment is categorized:
- Diagnostic: These are your most basic dental services needed to assess and evaluate what your future dental care looks like. Procedures include exams, x-rays, 3D imaging, etc. Most diagnostic services are covered in full, but only “allowed” on a set time frame, such as once every 1-5 years.
- Preventive: Prophylactic treatments help you prevent dental problems. They consist of cleanings, fluoride, sealants, etc. Again, your fee schedule will probably only allow 1-2 of these per year.
- Basic and Major Treatments: When you need a few fillings placed or a root canal completed, the fee schedule shows how much is covered under your insurance. Anything that goes over that amount will be charged to you directly.
As dental problems get worse, your coverage amounts get lower. The goal is to encourage plan members to seek routine preventive care, diagnosing and treating conditions earlier.
Using the Fee Schedule to Choose the Best Dental Plan
Comparison shopping for dental coverage is confusing if you aren’t sure what to look for. It’s best to start by seeing what the fee schedule will cover on the treatments that you need: such as exams, cleanings, and fillings. If you’re planning to have some major dental work done later on (such as implants, crowns, or bridges) you’ll want to check those fees too. Otherwise, you could be throwing your money away.
Your employer may give you an option to add or change your dental insurance policy to maximize your investment. But if you don’t have coverage through your job, there are other affordable solutions to consider.
Dental savings plans (or “discount dental programs”) allow enrollees to save a set 10-60% off of specific treatments, without any deductibles or annual maximum allowables (meaning you can have as much or as little dental treatment as you need.) To learn more about programs like these, contact LowerMyDentalBills.com for pricing and discounts.