By Leta Gail Doerr
Unless you work in the medical field, it is likely that terms like “Usual, Customary & Reasonable” or USR for short, “Allowed Amount/Annual Maximum” and “Schedule of Benefits” are just as foreign to you as knowing the difference between your incisors, canines, and premolars. Not to worry. Hope Perry, Office Manager of McLean County Dental in Bloomington, offers the following guide to understanding some very common dental terminology.
Knowing Your Insurance
Let’s face it. Dental care can be expensive—especially if you do not get regular check-ups and wait until a small problem becomes a big one. Knowing the terms and coverages associated with your dental care plan can help make your dental care as affordable as possible. Here’s a start:
Know the difference between in-network and non-preferred providers: In-network refers to a dentist that has contracted with your insurance plan to provide services. An out of network, or non-preferred dentist, is one that doesn’t have a contract with your insurance plan. You will pay more to see a non-preferred provider.
Know your plan and associated out of pocket costs: Every plan has coverages and provisions that are often misunderstood.
- “Allowed Amount/Annual Maximum” is the total dollar amount that a plan will pay for dental services in the benefit period, which is usually a calendar year.
- “Deductible” is the amount the patient owes for dental services before your plan begins to pay. Example: If your deductible is $50.00, your plan won’t pay until you’ve met your deductible for covered services. One caution: deductibles do not apply to all services.
- “Co-payment” is a fixed amount you pay for a covered service.
- “USR—Usual Customary & Reasonable” is the amount paid for service in your area based on what providers in your area usually charge for the same service. The UCR amount is used to determine the allowed amount.
Understand billing statements you may receive: Not all dental programs cover all services. You may receive the statements via mail, or the office staff at a dentist’s office may provide them to you.
- “Schedule of Benefits” is a listing of services with an assigned dollar amount that represents the amount that an insurance company pays for that dental service.
- “Fee Schedule” is a reimbursement plan that the dentist has agreed to accept as payment.
- “Predetermination” is a process by which the dentist submits a treatment plan to the insurance company for dental services needed. The insurance company then reviews the treatment plan and notifies the dentist of covered services, amounts payable, co-payments, deductibles, and plan maximums.
Engage the Office Staff
Now that you are familiar with the common terms, it is not necessary that you memorize them. The office staff are experts at knowing the nuts and bolts of dental plans. “In our area, we have dozens of plans and providers—each have their own niche. Knowing the differences and allowable coverages for Cigna, Metlife, Delta Dental, Geha, BCBS, Lincoln Financial Group, and more, are our specialty,” shares Perry.
Most people are anxious about visiting a dentist’s office, whether it is for routine dental care, or for a root canal. Couple this with determining how to pay for these services, and it is enough to make a person grind their teeth. Take some time to understand the terms, and remember to speak with the office staff so they may translate the terminology and set your mind at ease.
Hope Perry is the Office Manager for Dr. Emil Verban and his team of hygienists and assistants at McLean County Dental. Their office is located at 2103 E. Washington Street in Bloomington, and offers a wide range of services including preventative and routine care, cosmetic procedures, implants, root canals, and extractions. Contact them at 309- 662-8448 or visit www.mcleancountydental.com.