A dental fee schedule is like a price list for each type of dental work you may want to have done. A dentist may set up her own dental fee schedule or she may agree to use one that is part of a dental plan.
Dental Fee Schedule and Dental Insurance: What You Need to Know
If you think you may buy a dental plan, you should be aware of the fact that dental plans come in two basic types. One type of plan is called “fee for service,” and the other type is called “managed care.”
Unlike managed care plans, fee for service dental plans pay your costs only after they receive and review the bill. This means that when you use a fee for service dental plan you will need to make higher out of pocket payments. Some patients may see these higher payments as a useful expense, since fee for service plans let their patients choose to receive dental care from among more dentists than do managed care plans.
Yet, while managed care dental plans place more rules on the range of dentists from which you can seek care and still keep all of the plan’s benefits, you should note that such plans also make the dentists they work with use the plan’s dental fee schedule.
This is good to know because the dental plan’s dental fee schedule is most often ruled by a top limit known as a UCR (usual, customary, and reasonable) fee. What is “usual” or “reasonable” is set by the dentist. The number deemed “customary” is set by the dental plan provider. The two parties’ numbers do not always match up.
If you have a managed care dental plan, in most cases the dentist has agreed up front to the fee schedule that has been set by the dental plan. If you have a fee for service plan, you do not have the same assurance as a rule. You may then end up with higher fees for certain types of dental work.
No matter which type of dental plan you choose, be sure you get to know the plan’s fee schedule. This lists how often the plan’s fee levels are changed as well as the means by which these updates will be shared with you. It is also vital that you learn what part of the cost the dental plan will pay for the types of work that are spelled out in the dental plan’s fee schedule.