What Is “Usual, Reasonable, and Customary”?

In the description of benefits you get with your dental plan, you might come across a strange set of initials: UCR. Knowing what those initials stand for — and how they affect your insurance plan — can help you make sure you choose the right dental policy.

UCR stands for “usual, reasonable, and customary.” That's a way for insurance companies to say, “this is what your dentist should charge.” For example, it's common for a plan to cover “80% of the UCR” for a certain treatment.

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The idea of UCR is used in many health insurance plans, but it's especially common in dental plans — particularly indemnity dental plans.

Where It Gets Confusing

So how does a plan figure out what the usual, reasonable, and customary amount to pay for a treatment is? That's where it gets tricky.

Every insurance company does it differently. Some are willing to share the amounts they'll pay up front. Others are not. Many insurance companies treat their “fee schedules” as closely-guarded business secrets.

Doctors and dentists don't always help the situation, either. Many healthcare professionals don't like talking about cost before they've treated you.

Between tight-lipped insurance companies and dentists who prefer that you didn't ask about price, how are you supposed to make sure you don't get over-charged and under-covered?

Two Things You Should Do

Here are two things you can do to prevent getting hit with unexpected bills:

• Try finding out how your insurance company defines UCR. Your insurance agent can be a big help here. An insurance company might release how it defines UCR — but keep it buried somewhere in the fine print. Agents are experts at making sense of complicated insurance documents.
• Find out what your dentist charges for a particular treatment. They may not want to tell you, but as a patient you have the right to ask. If they aren't willing to share, it might be time to find a new dentist.

If you know that your insurance company considers $200 to be the UCR fee for a tooth extraction, and your dentist wants to charge you $300, you can save yourself an expensive surprise. Shopping around for dental care takes more research, but it can save you money.

If you go with a managed care dental plan, you'll be able to avoid most of these headaches. In managed care plans, the insurance company negotiates with providers what fees can be charged. As long as you get your care from a dentist in the plan's “network,” there should be no question of coverage.

Who knew that something as simple as keeping your teeth healthy could get so complicated? That's just one reason why working with an insurance agent makes so much sense. To get matched with professional agents licensed in your area, use our free online dental quote service.