Out of Network Care

Visiting an out-of-network dentist

Your Regence dental plan allows you to see the dentist of your choice—in network or out of network.

Coverage for your out-of-network dental visits is determined by UCRs, which stands for usual, customary and reasonable charges. UCRs are benchmark fees for specific procedures that are based on what providers in a geographic area charge on average. UCR values are based on the average cost of procedures in a geographic area defined by the first three digits in the provider’s office ZIP code. Dental plans typically set a percentage of UCR as the basis for reimbursements for out-of-network care. Your plan features a 90th percentile of UCR out-of-network provider reimbursement. This means the UCR value for a given procedure is based on the fact that 90% of providers in their coverage area charge that amount or less. This amount is the maximum your dental plan will pay for a covered service from an out-of-network provider.

Example: If you have a tooth extracted, and your plan covers the procedure at 80% coinsurance with out-of-network reimbursement set at 90th UCR, that means that 90% of the dentists in the ZIP code would charge that amount or less for the extraction than your plan covers. If the 90th UCR for an extraction is $110 in the area, the Regence dental plan will cover 80% of $110 for the procedure, or $88. If your dentist charges $125 for the procedure, your plan will pay $88 and you will owe the remaining $37. If the dentist charges less than the 90th UCR, your plan will pay 80% of that dentist’s charge, and you’ll be responsible for the remaining cost.