Insurance companies establish UCR fees, as explained below:
- A “usual” fee is the fee that an individual dentist most frequently charges for a specific dental procedure.
- A “customary” fee is the fee level determined by the administrator of a dental benefit plan from actual fees submitted for a specific dental procedure. This fee establishes the maximum benefit payable for that procedure.
- A “reasonable” fee is the fee charged by a dentist for a specific dental procedure that has been modified by complications or unusual circumstances.Therefore, it may differ from the dentist’s usual fee or the benefit administrator’s customary fee.
The concept of using UCR fees to determine how much to reimburse patients covered by dental insurance for specific treatment was introduced by the insurance industry in the early 1960s.