Insurance Terminology Flashcards
The effective date of dental coverage is called?
Eligibility Date
A list of charges for dental services and procedures established by the dentist or a dental benefits provider and mutually agreed on?
Fee Schedule
A method of changing a reported benefits code by third party payers to reflect a lower cost for the procedure?
Down Coding or Down Grading
The portion of the service fee that remains after payment is made by the dental benefits plan and is payable by the patient?
Co Pay
A standardized list of terms and codes established by the American Dental Association for the purpose of consistency in reporting dental services and procedures to dental benefits plans?
CDT Codes
The fee that the patient is responsible for paying before the insurance company will consider payment of the balance of charges?
Deductible
A method of financial assistance the helps pay for specified procedures and services concerning dental disease and accidental injury to the oral structure ?
Dental Insurance
Persons who are covered under another persons dental policy?
Dependent
The total amount of dental benefits that will be paid for an individual or family for the purpose of dental services and procedures?
Maximum Benefits
A dentist who has contracted with a dental benefits organization to provide dental care to specific employees?
Participating Dentist
A person who has enrolled with an insurance company to provide payment for dental services and procedures?
Insured
A clause in most dental insurance policies that limits the coverage for conditions that existed before the patient enrolled in a plan?
preexisting
What does it mean if your maximum runs on a calendar year?
Jan 1st to Dec 31st
What organization issues the (CDT) Current Dental Terminology Codes?
ADA American Dental
Association
