Joy C. Arend, DMD

Demystifying Insurance: Part 1

Demystifying Insurance: Part 1

Demystifying Insurance

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.

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