Usual & Customary. What Does it Mean?

 

Every once in a while a patient calls us after receiving a statement from their dental insurance company and asks:

Every once in a while a patient calls us after receiving a statement from their dental insurance company and asks:

“Your fee for this is over what my dental insurance company calls ‘usual and customary,’ does that mean you are overcharging me?”

That’s a good question, one we’re happy to answer.

Each separate insurance company has its own “usual and customary” fees for all dental procedures for a certain geographical region. When our state dental association asks these companies for data to see how the numbers were arrived at and which dentists (if any) were surveyed, they are told that this is privileged company information and they do not reveal that.

If this survey was done fairly and truly represents the fees in a given area, then why can’t we see how it is done?

No dentist that I ever spoke to about these “surveys” was ever surveyed by any insurance company, and I spoke to hundreds of dentists over the years.“or this is over what my dental insurance company calls ‘usual and customary,’ does that mean you are overcharging me?”

That’s a good question, one we’re happy to answer.

Each separate insurance company has its own “usual and customary” fees for all dental procedures for a certain geographical region. When our state dental association asks these companies for data to see how the numbers were arrived at and which dentists (if any) were surveyed, they are told that this is privileged company information and they do not reveal that.

If this survey was done fairly and truly represents the fees in a given area, then why can’t we see how it is done?

No dentist that I ever spoke to about these “surveys” was ever surveyed by any insurance company, and I spoke to hundreds of dentists over the years.

The fact is that different insurance companies have different “usual and customary” fees for the same area.  If the calculations were done correctly they should all have the same fees.  But they don’t! In fact the ranges are quite broad.

Because the insurance companies establish artificially low fees in an effort to keep their profit margins as high as possible, animosity can be created between the dentist and the patient.  The insurance companies’ main goal is to collect as much in premiums as possible while paying out as little as possible and delaying payment for as long as possible. That is how they make their money.  Unlike us, they do not have the patients’ best interest at heart.

What is Dental Insurance?

Dental insurance is nothing more than a contract between the employer and the insurance company to partially pay for certain services.  It exists to help in covering the costs; it was never intended to cover all the costs. There are deductibles, some services get paid at 50 % or 85 % and some aren’t covered at all.

The type of insurance coverage your employer is willing to buy is determined by how much the employer is willing to pay for.  The employer selects as many or as fewer benefits they want.  The higher the premium paid by your employee – the higher is your usual and customary fee.

The annual dental insurance maximums were supposed to increase with inflation. When they were established in the 1960’s they were around $1000; filling were about $25 and crowns were about $200  A person could get a lot of dentistry done in one year. Almost 60 years later, today the insurance maximums are between $1500 and $2500 and an average filling is about $200 while a crown is about $1400. If a person needs one crown and a few fillings in one year their insurance benefits are exhausted. The insurance companies did not keep their promise. 

How Are Our Fees Set?

Our fees are set by the actual cost of doing business in this particular office.  Costs vary from office to office depending on rent, the salaries of out employees, quality of materials used, lab costs and many other "cost of doing business" factors.

The truth is you would be surprised at the lengths we go to in order to keep costs down while maintaining a high level of service.  We have never tried to be the cheapest because there is a standard of quality we will not go below. We strive to provide the best dental care for our patiens.

For example, we will not compromise on sterilization because it’s just too important for our patients.  Likewise we will not use inferior materials for our dental restorations just to “save money”.  The fact is you never save money this way because the cheaper materials don’t last as long and the patient ends up back in the dental chair in a few years complaining that their crown or filling failed. We hire only the best, well trained staff, who love their jobs and give 110% every day to our patients care and customer service.

I won’t go the cheapest care route . And I wanted you to know why.

Sincerely,

Alex Shvartsman, DDS
Master of the Academy of General Dentistry
Fellowship in Dental Implants and Advanced Prosthetics