![]() ![]() If you go out of network, then the insurance company will only pay the “reasonable and customary” reimbursement rate for that service. Out of network providers, however, can charge whatever they want. They MUST accept the insurance company’s payment in full (less any deductible or coinsurance you may be responsible for). This NEVER applies if you are using in-network providers. This national database takes into account that the cost of living and cost of services will vary by geographic region. All insurance companies use a national database that tells you what 8 out of 10 providers within a certain area are charging for services. These are all terms that apply specifically to out of network claims for both your medical and dental plans. “Reasonable and Customary (R&C)” and “Usual Customary and Reasonable (UCR) Charges” and “Balance Billing” – What Does This All Mean? You do not select a primary care dentist and you have complete freedom to access care from any certified dental provider.īenefits are paid at “Reasonable and Customary” rates according to the specific benefit plan displayed in the dental section of this website. You are not confined to a network of participating dentists. What is an "PPO Dental Plan" and How Does It Work?Īn PPO Dental Plan means that you can go to any dentist of your choice.
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