When members use an OON (out-of-network) provider, the cost of their procedures may vary from that which they’d see INN (in-network). UCR (Usual, Customary and Reasonable) and MAC (Maximum Allowable Cost) determine how their dental insurance will pay for the procedures.
UCR (Usual, Customary and Reasonable)
If a member has a UCR-based plan, providers charge a fee that has been set as the most commonly charged amount for that procedure
in that location. This reimbursed amount is determined by analyzing claims data in a specific geographic location.
MAC: Maximum Allowable Charge
If a member has a MAC-based plan, providers charge any fee that they have set for a procedure. The reimbursed amount a member
will receive is negotiated between the insurer’s in-network providers and the insurance company.
Our dental partners at Beam Dental have provided some detailed information, download it by clicking this link: UCR_vs MAC
Questions about your health or dental insurance? Contact your Total Benefit Solutions health insurance experts today at (215)355-2121