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Insurance Terms

 

Due to the changes in dental coverage, the following list will provide you with some information regarding commonly used insurance terms.


  • Annual Maximum - Most Insurance companies have an annual maximum amount of coverage for each patient listed under the insurance policy. This coverage may be changed without notice to patients.
  • Assignment - of insurance is when the patient signs a section of the insurance form, which allows the dentist to receive payment directly from the insurance company, instead of having the patient pay the dentist and then wait for their insurance claim. However, patients are responsible for the "Out of Pocket Portion" at the time of treatment and any treatment that may no longer be a covered expense. Insurance companies now often send payment to the patient. This should be forwarded to the dentist as soon as possible.
  • Co Payment - or "Out of Pocket Portions" are part of the treatment fee not covered by dental insurance. The insurance company will pay a certain percentage of the treatment, but they rarely cover 100%

  • Deductible - The dollar amount the patient pays toward their treatment total before insurance coverage begins.
  • Dual Coverage - is when both spouses are covered by different insurance plans. The insurance companies usually coordinate the benefits so that the patient does not receive more than 100% of the cost of treatment.

  • Eligibility - Eligibility determines who is covered under the insurance policy

  • Exclusions - Many dental services and treatment that are clinically necessary are not covered by dental insurance. These exclusions are usually described in the patient's insurance booklet, but be aware that more treatments are being excluded constantly to reduce costs