How does my insurance carrier come up with its’ allowed payments amounts?

Dr. Sheila Dobee

Family, Cosmetic and Implant Dentist

Date : 06/05/2020

Many companies refer to their allowed payments as UCR, which stands for Usual, Customary and Reasonable. Sadly, “usual, customary and reasonable” does not really mean what it sounds like. UCR is actually a listing of payments for all covered procedures negotiated by your employer and the insurance company. This listing is related to the cost of the premiums and also where you are located in your city and state.

Your employer has likely selected an allowed payment or UCR payment they’ve budgeted for the plan’s premium. It may not consider other factors you may see as important. These factors include the patient experience, experience and skill level of doctor. Also, insurers may not care about the quality of materials used in your mouth. Nor do they always take into account the quality of technology, or labs used for any required lab work.