Benefit Schedule Vs. Usual, Customary and Reasonable (UCR)
When you are reviewing dental insurance plans that shows benefits on a fee schedule (like an HMO dental insurance plan) the schedule of benefits listed shows the amount to be paid for each treatment or dental services render under the plan. Thus letting you know your cost ahead of time for each dental service covered under the plan.
When you are reviewing insurance plans that pay coverage’s based on usual, customary and reasonable (like PPO dental insurance plans) charges does will not specify an amount; it provides benefits up to the reasonable and customary charge (the prevailing or average fee charged by dentist for the service in the area) Coverage’s are normally paid by a percentage ( Example: 100% for preventive 80% for basic and 50% for major dental services up to UCR )