Usual, Customary and Reasonable
Many people receive notification from their insurance company that dental fees are
"above usual and customary". An insurance company
sometimes determines their reimbursement level by surveying a geographical
area, calculating the average fee, then determines that 80%
of the average fee to be customary. Included in this survey
are discount dental clinics and managed care facilities,
which have severely reduced dental fees that bring down the
average. Each insurance company has their own formula to calculate different UCR’s.
Most doctors in private practice will have fees that insurance companies define as "higher
than usual and customary."