Terminology Reminder: What to Use Instead of Outdated UCR

Many dental offices still refer to “Usual, Customary, and Reasonable” (UCR) fees. However, Delta Dental no longer uses the term “UCR” on our Explanation of Benefits. We replaced UCR with the following terms several years ago. The new terms are clear, straightforward, and understandable to dentists and patients alike.

Approved Amount: The total amount which the dentist is permitted to collect as payment in full for the specified service. It includes the dental benefit plan's payment as well as the patient's deductible and/or copay.

Amount Used for Benefit Calculation (ABC): The fee amount that the dental benefit plan provides for use in calculating the dental benefit plan payment for the specified service. The dental benefit plan payment may be less than this fee amount due to patient deductible, copay, plan limitations, or exclusions.

Coordination of Benefits Calculation: Maximum Allowable Charge (MAC). For certain groups, when Delta Dental is the secondary payer in accordance with the State of New Jersey rules for coordination of benefits, the Maximum Allowable Charge is based upon the primary payer’s approved allowances.