Part One: Basic Terminology
UCR: The maximum allowable amount that will be covered by the plan. UCR stands for”usual,” “customary,” and “reasonable.”
Annual Maximums: The largest amount that a dental plan will pay annually.
Preferred Providers: Dentists who have a contract with the insurance plan.
Pre-existing Conditions: Conditions that existed prior to enrollment in a dental plan.
Coordination of Benefits (COB): Term that applies to patients who are covered by more than one dental plan.
Plan Frequency Limitations: The number of times that a dental plan will pay for a particular treatment.
Not Dentally Necessary: Term that designates procedures that an insurance plan considers not medically necessary and thus not covered.
Bundling: The insurance company combines two different dental procedures into one procedure.
Downcoding: The insurance company adjusts the procedure code to one less complex or costly than your dentist has reported.
Least Expensive Alternative Treatment (LEAT): A clause that stipulates that insurance will only pay for the least expensive way to treat a condition.