Dental Insurance and Discount Plans

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About Dental Fee Schedules

A dental fee schedule is a price list for dental procedures. Dental fee schedules may be established by a dentist herself or a dentist may agree to a dental fee schedule as a part of a dental plan put in place by a dental insurance company.

Dental Fee Schedule and Dental Insurance: What the Patient Needs to Know

It is important for the patient considering purchasing a dental insurance plan to be aware of the fact that dental insurance plans are commonly divided into two types: fee-for-service and managed care. Unlike managed care providers, fee-for-service dental plan providers make payments only after receiving and reviewing a bill, which means that patients participating in fee-for-service dental plans make higher out-of-pocket payments. Some patients may regard these higher payments as an expense worth incurring, given that fee-for-service dental plans offer their patients a greater array of dentists from which to receive dental care than do managed care plans. However, while managed care dental plans place more restrictions on the range of dentists from which a patient can seek care (while still maintaining all of the plan’s benefits), it is worth noting that they typically lock their contracted dentists into the insurance company’s dental fee schedule.

This is important because the dental insurance company’s dental fee schedule is usually subject to a ceiling known as an UCR (Usual, Customary, and Reasonable) fee. What is “usual” or “reasonable” is determined by the dentist in question, while the figure deemed “customary” is determined by the dental plan provider––and the two parties’ numbers do not always match. While patients participating in a managed care dental insurance plan can typically rest assured that the dentist has agreed in advance to the fee schedule as determined by the dental insurance provider, those participating in fee-for-service dental plans do not normally have the same assurance, and may therefore end up with higher fees for certain dental procedures.

Whether choosing a fee-for-service or a managed care dental plan, patients should acquaint themselves with several aspects of the dental plan’s fee schedule. These include the frequency of fee level updates, as well as the means by which these updates are communicated to the patient. It is also obviously important to be acquainted with the percentage of the cost the dental plan provider is committed to paying for those procedures enumerated in the dental plan’s fee schedule. If these and related provisions of a given dental plan appear satisfactory to the inquiring patient––and if the premium for the dental plan is affordable––the plan may be a sensible dental insurance option.

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