1. What is a “UCR” and how is it determined?
“UCR” is the term used by insurance companies to describe the amount they are willing to pay for a particular endodontic procedure. There is no standard fee or accepted method for determining the UCR and the UCR has no relationship to the fee charged our office. The administrator of each dental benefit plan determines the fees that the plan will pay, often based on many factors including region of the country, number of procedures performed and cost of living.
2. Why was my benefit different from what I expected?
Your dental benefit may vary for a number of reasons, such as:
• You have already used some or all 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 yet met your deductible.
• You have not reached the end of your plan’s waiting period and are currently ineligible for coverage.
3. Why isn’t the recommended treatment a covered benefit?
Dr. Howard and Dr. Camba diagnose and provide treatment based on their professional judgment and not on the cost of that 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 Dr. Howard and Dr. Camba deemed the treatment necessary.
4. How do I know what my payment portion will be if my insurance does not cover the entire fee?
Your payment portion will vary according to the UCR of your plan, your maximum allowable benefit, and other factors. Ultimately, the patient portion is not known until the insurance check has been received by our office. We do strive to estimate final costs to the best of our ability but final fees can change.
5. How do I understand my Explanation of Benefits (EOB)?
Your Explanation of Benefits (EOB) is a wealth of information. The EOB identifies the benefits, the amount your insurance carrier is willing to pay, and charges that are and are not covered by your plan. The statement includes the following information: UCR, copayment amount/patient portion, remaining benefits, deductible, and benefit paid.
6. How long does it take for a claim to be paid?
The time for a dental insurance carrier to process an insurance claim varies. At least 38 states have enacted laws requiring dental insurance carriers to pay claims within a timely period (ranging generally from 15 to 60 days). If you want to file a complaint about a delayed payment, contact the insurance commissioner in your state. They want to know if your insurance company does not pay within the period allowed by your state law.