Insurance companies on an individual basis come up with "usual and customary" fees for all dental procedures for a certain geographic region. When our state dental association asks these companies for data to see how the numbers were arrived at and who, if any, dentists were surveyed, it is told categorically by every insurance company that this is confidential, internal information and it will not be revealed.

Our answer is, "If this survey was done fairly, and truly represents the fees in a given area, then why can't someone see how it was done?" The insurance industry seems to be incapable of understanding this type of logic. The fact is that different insurance companies have different reasonable and customary fees for the same area. If the calculations were done correctly and fairly, they should all have the same fees. They do not because the calculations were not done fairly or correctly. The insurance company's only reason for establishing artificially low "reasonable and customary" fees is to cause animosity between the dentist and the patient. It is the insurance company's hope that the dentist will then lower his or her fees so that the company will then have to pay out less money.

A dental plan is nothing more than a contract between an employer and an insurance company to partly pay for certain services. There are deductibles, some services are paid on a percentage, and some are not covered at all. Your employer buys a contract at a specified premium which includes as many or as few benefits as the employer is willing to pay for. It is a well-known fact within the industry that a higher premium paid by the employer will get you, the patient, a higher "usual and customary" fee schedule. Currently, some state dental societies and the ADA are engaged in a lawsuit with a large dental insurance company regarding this fraudulent practice.

Our fees are set by the actual costs of doing business in this particular office. Obviously, costs can vary from office to office depending on the quality of service, lab costs, material used, and many other factors. Our fees reflect the quality of service and care with which it was delivered.