Will I receive notice of how much my insurance company will pay?
Your insurance company will mail you an EOB (Explanation of Benefits) outlining the details of your processed claim. The EOB contains the following information: UCR, patient portion, remaining benefits, deductible, and benefit paid.
Why is my benefit different from what I expected?
- You have already used some of the benefits available from your dental insurance.
- Your insurance plan paid only a percentage of the fee charged by your Endodontist.
- The treatment you needed was not a covered benefit.
- You have not met your deductible.
- You have not reached the end of your plan’s waiting period and are currently ineligible for coverage.
- Your plan may want you to choose your dental care from a list of their preferred providers.
- Specific plan limitations, like the re-treatment of an existing root canal.
What is Usual Customary and Reasable fees (UCR)?
“UCR” is the term used by insurance companies to describe the maximum amount they will allow for a particular dental procedure. There is no standard fee or accepted method for determining the UCR, and the UCR has no relationship to the fee charged by our office. The administrator of each dental plan determines the fees that their plan will pay, often based on many factors including region of the country, number of procedures performed, and cost of living.
Why isn’t the recommended treatment a covered benefit?
Our Endodontist diagnoses and provides treatment based on professional judgment and not on the cost of care. Some employers or insurance plans exclude coverage for necessary treatment as a way to reduce their costs. Your plan may not include this particular treatment or procedure, although the Endodontist deemed the treatment as necessary.