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Insurance Dictionary

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


Members have the option to select their dentist at the time they are seeking treatment.
  • 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.
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.
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.