If your benefits are calculated using a Table of Allowances, the table might be out of date or set at an unrealistically low amount. If your policy provides for the least expensive treatment, you will be reimbursed the stated percentage based on the cost, even if you choose alternate treatment. As a result, your dental benefits might only be available by seeking care from a dentist who has contracted with that company. If that group experiences an unexpected high utilization of major dental services, the premiums will go up. Insurance company administrative costs and premium taxes also contribute to the cost of dental coverage.
Insurance companies pay claims in various ways.
Many base reimbursements on UCR rates. However, even the UCR allowance may vary from company to company. While these reimbursements usually are based on what the majority of dentists in your area charge, sometimes the figures used to calculate benefits may be out of date or not specific to your location. And, if the company uses a Table of Allowances, benefits assigned to specific dental treatment may not relate to actual costs. Dental benefit plans help you pay for certain kinds of dental care.