Drs. Golovan & Golovan
Norman Golovan D.D.S. 
Bruce Golovan D.M.D.
Family & Cosmetic Dentistry

28790 Chagrin Blvd. #300
Woodmere Village, OH 44122
(216) 591-0022
Designing Healthy and Beautiful Smiles!

Call for an appointment today!
(216) 591-0022
Cost-Control Measures Used by Dental Benefit Plans
Key terms used to describe the features of a dental plan may include the following:
UCR (Usual, Customary, and Reasonable) Charges: UCR charges are the maximum allowable amounts that will be covered by the plan.  Although these terms make it sound like a UCR charge is the standard rate for dental care, it is not.  The terms "usual", "customary" and "reasonable" are misleading for several reasons:
-Insurance companies can set whatever amount they want for UCR charges.  They may not match current actual fees charged by dentists in a given area.
-A company's UCR amounts may stay the same for many years.  They do not have to keep up with inflation or the costs of dental care.
-Insurance companies are not required to say how they set their UCR rates.  Each company has its own formula.

If your dental bill is higher than the UCR, it does not mean your dentist has charged too much.  It could mean your insurance company has not updated its UCR charges.  It could also mean that data used to set the UCR is taken from areas of your state that are different from yours.
Annual Maximum- This is the largest dollar amount a dental plan will pay during the year.  Your employer decides the maximum levels of payments in its contract with the insurance company.  You are expected to pay co-payments and any costs above the annual maximum.  Annual maximums are not always updated to keep up with the costs of dental care.  If the annual maximum of your plan is too low to meet your needs, ask your employer to look into plans with higher annual maximums.

Preferred Providers- The plan may want you to choose dental care from its network of preferred providers.  The term "preferred" means these dentists have a contract with the dental benefit plan; it does not mean these are dentists that you will necessarily prefer or that they will provide the care that you would prefer.  If you get dental care from a dentist who is not in the network, you may possibly have higher out of pocket costs.  Please see our Out Of Network vs. In Network page for more information on this subject.

Pre-Existing Conditions- A dental plan may not cover conditions that existed before you enrolled in the plan.  For example, benefits will not be paid for replacing a tooth that was missing before the effective date of coverage.  Even though your plan may not cover certain conditions, you may still need treatment to keep your mouth healthy.

Coordination of Benefits (COB) or Nonduplication of Benefits-
These terms apply to patients covered by more than one dental plan.  The benefit payments from all insurers should not add up to more than the total charges.  Even though you may have two or more dental benefit plans, there is no guarantee that all of the plans will pay for your services.  Sometimes non of the plans will pay for the services you may actually need.  Each insurance company handles COB in its own way.  Please check your plans for details. 

Plan Frequency Limitations- A dental plan may limit the number of times it will pay for a certain treatment.  But some patients may need treatment more often than others to maintain good oral health.  For example, a plan might pay for a teeth cleaning only twice a year even though the patient may need a cleaning four times a year.  Make treatment decisions based on what's best for your health, not just what is covered by your insurance plan.

Not Dentally Necessary-
Many dental plans state that only procedures that are medically or dentally necessary will be covered.  If the claim is denied, it does not mean that the services were not needed.  Treatment decisions are made by you and your dentist.  If your plan rejects a claim because a service was "not dentally necessary," you can appeal.  Work with your benefits manager and the plan's costumer service department to appeal the decision in writing.