Frequently Asked Questions

Q: How does a Managed Care Plan (Option I) work?

A: Your Managed Care Plan (Option I) is designed to reduce the out-of pocket expense to members. This plan requires assignment to a participating general dentist and requires that members stay within the network of participating providers. Members pay applicable co-payments directly to the provider.

Q: How is treatment by specialists accessed?

A: Your Managed Care Plan (Option I) requires that members stay within the network of participating specialists. In the event that the services of a specialist are required, the member may be referred by his/her assigned general dentist to a participating specialist or the member may self-refer. Members pay applicable co-payments directly to the provider.

Q: What is the referral process?

A: It is not necessary for the member to obtain authorization from CompBenefits prior to seeking treatment from a participating specialist.

Q: What are resin composite fillings?

A: Resin composite fillings refer to a broad category of tooth colored restorative materials. These fillings have become popular for two reasons: 1) They are more aesthetically pleasing and 2) They require less tooth preparation and preserve more tooth structure.

Q: What is UCR?

A: UCR stands for Usual, Customary and Reasonable fees. These are the average fees charged by practicing dentists in a geographical area. UCRs are used to process PPO/Indemnity claims in a manner that is both fair and reasonable for the member, the provider, and the insurance company. Several companies specialize in compiling the UCRs throughout the country. The averages are determined by taking a sampling of the fees charged per procedure by dentists in a specific zip code or region.

Q: How are claims paid under the High Option Plan, (Option II)?

A: Under the High Option Plan, (Option II) the UCR chosen to process claims is the 90th percentile. This means that 9 out of 10 dentists in a given area charge fees that are consistent with the averages determined by the companies specializing in calculating UCRs.

Q: How are claims paid under the Low Option Plan, (Option III)?

A: Under the Low Option Plan, (Option III) the UCR chosen to process claims is the 80th percentile. This means that 8 out of 10 dentists in a given area charge fees that are consistent with the averages determined by the companies specializing in calculating UCRs.