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Dental Insurance Terms

Assignment of benefits

Authorization from the patient to the insurance carrier to forward payment directly to the endodontist for treatment provided.


Claim

A statement sent to an insurance carrier that lists the date of service and performed procedures with associated costs. It serves as the basis for insurances to provide payment of benefits.


Contract

An agreement between your employer and your insurance carrier that typically describes the benefits of your dental plan.


Copayment

A fee that your insurance plan may require you to pay in order to receive a specific dental procedure


Coverage

The benefits available to you under your insurance plan.


Customary fee

The fees your insurance carrier will pay for the specific procedure performed as opposed to the actual fees submitted for a specific endodontic procedure to establish the maximum benefit payable for that specific procedure.


Deductible

The amount you are responsible to pay before your insurance carrier starts paying for covered services.


EOB (Explanation of Benefits)

Identifies your benefits, the percentage your insurance carrier is willing to pay, and procedures that are and are not covered by your plan.


Participating provider

An endodontist who signs a contractual agreement with the dental insurance carrier to provide care to eligible members.


Patient portion

The dollar amount that you will be responsible to pay if your insurance payment does not cover the entire fee.


Preauthorization

A statement from your insurance company indicating whether the required endodontic treatment will be covered under the terms of your plan.


Predetermination

An administrative procedure that requires your endodontist to submit a treatment plan to your insurance carrier for approval before treatment begins.


UCR (Usual, Customary and Reasonable)

A term used by insurance companies to describe the amount they are willing to pay for a particular procedure.