X-rays, and fillings, and crowns! Oh, my! If you have dental insurance then consider yourself fortunate. Nevertheless, do you know precisely what your dental insurance covers, and what it doesn’t?

Alright, before we get started let’s talk UCR fees to reduce any confusion. Most dental insurance companies utilize a “Usual, Customary and Reasonable” (UCR) fee guide to determine the portion of the dental treatment they will pay.  In other words, insurance companies decide the price based not on what a dentist actually charges, but on what the insurance company believes is a “usual, customary and reasonable” fee for dental service. With that in mind, the insurance companies break down their coverage types into 3 main groups- Preventative, Basic and Major.

Preventative – Preventative dental services include routine cleanings, examinations, x-rays, sealants, and fluoride treatments. But wait, here’s the confusing part! Some of these items are considered preventative OR basic so it depends upon your insurance company. The good news is that the majority of insurance companies will cover 80-100% of UCR fees for these services!

Basic – Basic and restorative services include fillings, fixing chipped teeth, simple tooth extractions, periodontal treatment and occasionally crowns and root canals.  Once again, this depends upon the insurance provider. Typical insurance coverage is around 80% of UCR fees.

Major – Major dental services are exactly that- major. These generally include crowns, bridges, dentures, partials, surgical tooth extractions and any other large, expensive dental procedures. On average, the insurance coverage is around 50% of UCR fees.

So, what do insurance companies NOT cover?

Well, basically anything considered to be “cosmetic dentistry”. This includes porcelain veneers, bleaching trays or tooth whitening procedures, tooth bonding to correct spaces between teeth and some dental implants.  Overall, it is vital to analyze your insurance policy’s premiums, deductibles, and annual maximums specific to your dental insurance that meets your unique needs.

-Katie

X-rays, and fillings, and crowns! Oh, my! If you have dental insurance then consider yourself fortunate. Nevertheless, do you know precisely what your dental insurance covers, and what it doesn’t?
Alright, before we get started let’s talk UCR fees to reduce any confusion. Most dental insurance companies utilize a “Usual, Customary and Reasonable” (UCR) fee guide to determine the portion of the dental treatment they will pay.  In other words, insurance companies decide the price based not on what a dentist actually charges, but on what the insurance company believes is a “usual, customary and reasonable” fee for dental service. With that in mind, the insurance companies break down their coverage types into 3 main groups- Preventative, Basic and Major.
Preventative – Preventative dental services include routine cleanings, examinations, x-rays, sealants, and fluoride treatments. But wait, here’s the confusing part! Some of these items are considered preventative OR basic so it depends upon your insurance company. The good news is that the majority of insurance companies will cover 80-100% of UCR fees for these services!
Basic – Basic and restorative services include fillings, fixing chipped teeth, simple tooth extractions, periodontal treatment and occasionally crowns and root canals.  Once again, this depends upon the insurance provider. Typical insurance coverage is around 80% of UCR fees.
Major – Major dental services are exactly that- major. These generally include crowns, bridges, dentures, partials, surgical tooth extractions and any other large, expensive dental procedures. On average, the insurance coverage is around 50% of UCR fees.
So, what do insurance companies NOT cover?
Well, basically anything considered to be “cosmetic dentistry”. This includes porcelain veneers, bleaching trays or tooth whitening procedures, tooth bonding to correct spaces between teeth and some dental implants.  Overall, it is vital to analyze your insurance policy’s premiums, deductibles, and annual maximums specific to your dental insurance that meets your unique needs.

-Kat

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3 Responses to “What Does Major Dental Insurance Cover and What Does It Not?”

  1. thornhilldental Says:
    May 9th, 2010 at 1:59 am

    Most dental insurances cover basic dental treatment including x-rays, fillings, extractions and root canals. Some cover crowns, bridges and dentures.
    Usually not covered by dental plans are cosmetic dental procedures such as veneers and teeth whitening.
    Thornhill dentist
  2. A. Vulpis Says:
    July 30th, 2010 at 5:33 pm

    Is there anywhere I can find out (free of charge) what the UCR fees are? I think my dentist is charging way too much.
    Thank You,
    A. Vulpis
  3. samanta Says:
    August 30th, 2010 at 5:10 am

    gO6Ol5 http://djb3jDdmjckow30cnjcmd61l0dy.com

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