My insurance statement’s Explanation of Benefits (EOB) says my dentist exceeded the “usual, customary, and reasonable” (UCR) fee. Was I overcharged?
No. Insurance carriers set arbitrary reimbursement levels, defining for themselves what is “usual, customary, and reasonable.” The American Dental Association has recently received a favorable federal ruling in two separate class action suits trying to clarify this misleading terminology. You’ll find most dentists in the metropolitan DC area exceed the insurance companies’ definition of UCR.
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