Terms Insured Patients Should Know
Most insurance companies have an annual maximum amount of coverage for each patient listed under the insurance policy. This coverage may be changed and patients may not be informed.
The dollar amount the patient pays toward their treatment before insurance coverage begins.
Eligibility determines who is covered under the insurance policy.
Many dental services and treatments that are clinically necessary are not covered by dental insurance. These exclusions are usually described in the patient's insurance booklet, but you should be aware that more treatments are being excluded constantly to reduce costs.
This "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 very rarely cover 100%.
This 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.
This 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. Some insurance companies send payment directly to the patient. In such cases, assignment is prevented by the employer or the insurance company policy. Therefore payment arrangements must be made at the time of treatment.