If you have a dental PPO or Indemnity Plan: These are types of dental insurance plans where you can go outside the network or choose your dentist. Going to any dentist significantly benefits people, which is why these types of plans are favored.  

However, more work is placed on you (the insured) when it comes to filing claims. Even though the dental office may call the insurance company regarding coverage, it is up to you to ensure you are covered and for how much. You can submit a quote to the claims department before the work starts or call. 

Many PPOs or Indemnity Plans pay based on % up to ACV/UCR, so even though you may have coverage, you can get hit by a hefty bill if your dentist is above the ACV/UCR. (I advise submitting claims as quotes before proceeding with the dental services. Some PPOs will require submitting a quote for any dental service over $300.00, which helps you know your service cost. Remember that even the dental insurance company will say what they provide is an estimate, and the price can vary depending on when and what is submitted to them.

What is ACV/UCR Fees?

ACV stands for Actual Cash Value, and UCR stands for Usual, Customary, and Reasonable fees. In dental insurance, ACV/UCR is the maximum amount of money that the insurance company will cover for a specific dental procedure. The insurance company determines the ACV/UCR based on the average cost of a particular procedure in a given geographical area. If your dentist charges more than the ACV/UCR, you will be responsible for paying the difference. 

Since you can choose your dentist regardless of area or network, you will want to know if your dentist will be within the company ACV/UCR or understand if not, you can have a higher service cost.