Each insurance company pays their benefits according to a fee schedule they predetermine or by  their “UCR”.  UCR stands for Usual, Customary, and Reasonable for the region or area. Each company claims to arrive at their UCR by “surveying” area dentists. No dentists that we are aware of have ever been “surveyed”.

Every insurance company (when asked) claims to determine their UCR based on current local information but will not publish or explain how those fees are determined, just states their formula is proprietary.

If in fact they paid the average for the region then, logic dictates, every company would have similar UCRs. In fact they do not. They vary from insurance carrier to insurance carrier by a wide range, in some cases hundreds of dollars difference for some procedures.

The insurance industry is about making money and so, as with any business, the less they pay out, the higher their profit.

Unfortunately this can sometimes lead to strife between patient and provider when the UCR makes a patient feel like they are being over-charged. This could not be further from the truth. Unlike the insurance companies, we at Windsor Family Dentists have the best interest of our patients in mind and charge the lowest fees possible while still covering our own costs.