Glossary – Dental Insurance Common Terms

by | Jun 28, 2024 | Dental Insurance, Dentistry, Preventive, Sekhon Dental, Smile | 0 comments

At Sekhon Dental – Dentist Agoura Hills, we believe in educating our patients. We are a non-restricted PPO provider. Here’s a glossary of common terms related to dental insurance:

Annual Maximum: The maximum amount of money a dental insurance plan will pay for covered services in a policy year.

Basic Procedures: Common dental services beyond preventive care, including fillings, extractions, and minor oral surgeries.

Claim: A request for payment submitted by a policyholder or dental care provider to the insurance company for services rendered.

Coinsurance: The percentage of covered dental expenses that an insured person is required to pay after the deductible has been met.

Coordination of Benefits (COB): The process of determining the order in which multiple insurance plans will pay for a patient’s dental expenses when they are covered by more than one insurance policy.

Co-payment (Co-pay): A fixed amount an insured person pays for a covered dental service, with the insurance covering the remaining costs.

Coverage Period: The specific timeframe during which the dental insurance policy is in effect.

Deductible: The out-of-pocket amount an individual must pay before the dental insurance coverage begins.

In-Network Provider: A dental care provider who has a contract with a specific dental insurance plan to provide services at a discounted rate.

Major Procedures: Extensive dental treatments, such as crowns, bridges, dentures, and root canals, often requiring more time and resources.

Maximum Benefit: The maximum dollar amount that a dental insurance plan will pay for covered services over a specified period.

Network: A group of dentists, specialists, and dental care providers who have agreed to provide services at discounted rates for individuals covered by a specific dental insurance plan.

Orthodontic Coverage: Dental insurance coverage for orthodontic treatments, such as braces or other corrective appliances.

Out-of-Network Provider: A dental care provider who does not have a contract with a specific dental insurance plan.

Preauthorization: The process of obtaining approval from the dental insurance company before undergoing certain dental procedures or treatments.

Premium: The amount paid for a dental insurance policy, typically on a monthly basis.

Preventive Care: Routine dental services designed to maintain good oral health, such as cleanings, check-ups, and X-rays.

Waiting Period: The period during which an insured person must wait before certain dental services are covered by the insurance plan.

Understanding these terms can empower patients to make informed decisions about their dental insurance coverage and navigate the complexities of dental insurance plans more effectively. At Sekhon Dental – Dentist Agoura, we submit claims to insurance carriers so you don’t have to worry about it. Don’t hesitate to call us if you have any specific questions about your insurance plans.

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