Oral and Overall Health
UCR refers to the fee guidelines that are used to pay claims. UCR is used if you have a PPO plan but visit an out-of-network dentist.
It is important that you understand what level of UCR your plan pays, because it can affect the payment of your claim and your out-of-pocket costs. Your dental plan summary will tell you what your plan pays.
If your plan pays up to the 90th percentile, this means that 90% of dentists in a given area charge that fee or less.
Example of a UCR payment
The UCR fee at the 90th percentile in the following example is $1500
Dentist Charge for a Crown
Less: Usual, Customary and Reasonable (UCR)
Dentist Acceptable Charge
Patient Co-Insurance Payment
Patient Balance Bill for (Amount Exceeding UCR)
Total Patient Responsibility
Geographic differences in UCR fees
UCR fee levels differ from one state to another. The following map shows sample fees for a crown in different areas of the country. The figures used are at the 50th percentile which means that 50% of the dentists in those areas charge that amount or less for a crown.
Test your Usual, Customary and Reasonable (UCR) knowledge with this quick-to-complete quiz
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