Insurance Terms
This is the amount a patient must pay before insurance begins paying for covered services.
What is a deductible?
Dental insurance helps patients by doing this.
Sharing the cost of dental treatment.
Patients typically pay less when visiting this type of provider.
What is an in-network provider?
This is a request sent to insurance asking for payment.
What is a claim?
A patient had a cleaning four months ago, but insurance won't cover another cleaning yet.
What is a frequency limitation?
This is the maximum amount insurance will pay during a benefit year.
What is an annual maximum?
This type of plan provides discounted fees but does not pay for treatment.
What is a dental discount plan?
This fee is negotiated between an insurance company and an in-network provider.
What is a contracted fee?
This document explains what was billed, what insurance paid, and what the patient may owe.
What is an Explanation of Benefits (EOB)?
A patient enrolls in a new insurance plan and immediately wants a crown, but insurance will not contribute for twelve months.
What is a waiting period?
This is the percentage of treatment costs shared between the patient and insurance company.
What is coinsurance?
This insurance rule may require a patient to wait before certain services are covered.
What is a waiting period?
This term refers to the maximum fee insurance recognizes for a procedure.
What is an allowed amount?
This is the process insurance uses to review a claim and determine payment.
What is adjudication?
Insurance pays based on a less expensive treatment than the one recommended by the doctor.
What is a downgrade?
This person owns the insurance policy.
Who is the policy holder (subscriber)?
This insurance restriction limits how often a service may be covered.
What is a frequency limitation?
Patients may have higher out-of-pocket costs when visiting this type of provider.
What is an out-of-network provider?
This is submitted before treatment to estimate how insurance may contribute.
What is a predetermination (pre-estimate)?
A patient's insurance will not cover an implant because the tooth was missing before coverage began.
What is a missing tooth clause?
This family member receives benefits through another person's insurance plan.
Who is a dependent?
This term describes a service that qualifies for payment under an insurance plan.
What is a covered service?
True or False:
In-network providers generally make the claims process easier for patients.
True.
This gives insurance permission to send payment directly to the dental office.
What is assignment of benefits?
A patient's insurance has already paid $1,450 of a $1,500 yearly benefit.
What is an annual maximum?