Q:

How does a dental fee schedule work?

A:

Quick Answer

A dental fee schedule consists of dental procedures and the amounts insurance will pay dentists to perform those procedures, states Consumer Guide to Dentistry. Dentists who accept the insurance agree to abide by the insurance’s fee schedule and write off any difference between their customary charge and the fee schedule.

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Full Answer

A dental fee schedule is typically subject to a ceiling, and fees are commonly scrutinized to determine if they are usual, customary and reasonable, according to DentalInsurance.com. Whether a fee is “usual” or “reasonable” is determined by the dentist. Whether a fee is “customary” is determined by the dental plan provider with whom the dentist is contracted. Significantly, the two parties’ fees do not always match. Therefore, a fee schedule is arbitrated between the dental plan provider and the dentist so that charges are standardized and the continuity of care is not disrupted.

Dental fee schedules typically reduce the out-of-pocket expenses paid by patients with qualifying dental plans, says DentalInsurance.com. While traditional “fee for service” dentistry involves a dentist unilaterally dictating the fee for a particular service, patients with qualifying plans leverage the plan carrier’s ability to negotiate for discounted rates according to a predetermined fee schedule. Still, patients with qualifying plans should acquaint themselves with the frequency of fee level updates and how these are communicated to patients because insurance companies and dentists will periodically renegotiate their contracts with one another.

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