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Insurance glossary

Being familiar with insurance terminology helps you better understand your dental benefits.


POS (Point of Service)
Members have the option to select their dentist at the time they are seeking treatment.
PPO (Preferred Provider Organization)
  • Members have an incentive to select dentists who have agreed by contract to discount their fees.
  • Members have the freedom to choose any dentist, but members who receive treatment outside of the network pay higher co-payments and/or deductibles.
Participating Dentist
Any dentist who has a contractual agreement with a network plan to render care to members.
Either the employer (self-insured or self-funded), the insurance company or the TPA (Third Party Administrator) that finances or reimburses the cost of dental services.
Peer Review
A process established to provide for review by licensed dentists of the care provided by a dentist for a single patient, disputes regarding fees, cases submitted by carriers that are initiated by patients or dentists, and quality of care and appropriateness of treatment.
Statement by a third-party payer indicating that proposed treatment will be covered under the terms of the benefit contract. See also Precertification.
Confirmation by a third-party payer of a patient's eligibility for coverage under a dental benefits program. See also Preauthorization, Predetermination.