​I get a lot of questions from our patients about why they owe us money if their insurance covers 100% of their preventative care. Let’s take a moment to talk about what your insurance company is not telling you about your plan.
Dental insurance isn’t really insurance (payment to cover the cost of a loss) it is a benefit plan (such as a coupon or gift card) to help cover the cost of your dental care.
Your employer selects the benefit plan based on their budget and coverage available from the insurance company.
Insurance companies set up an amount that they are willing to pay for each procedure the dental office bills for. These amounts are called usual and customary rates (UCR). The amounts listed on the UCR are based on the company’s cost of premiums and desired profit levels.
These rates are different by geographic area and are generally lower that the fees charged by the dentist in your area.
Unfortunately, insurance companies do not disclose the UCR to a dental office out of network, making it impossible for an accurate estimate of your out of pocket expenses.
What does this mean for you?
If your plan states that a procedure is covered at 100%, they mean that they cover 100% of their UCR fee, not the fee of the dentist.
For example:
If we bill your insurance for a procedure that cost $80 in our office, but your insurance says their UCR fee for that procedure is $70, you will be left with a $10 balance after then insurance pays 100% of their UCR fee. 
Please let me know if you have any further insurance questions.
Rachel G. (512)-452-3077
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