Assignment of
benefits: Authorization from the
patient to the insurance carrier to forward
payment directly to the endodontist for
covered procedures.
Claim: Statement sent to
an insurance carrier that lists the
treatment performed, the date of that
treatment and an itemization of associated
costs. It serves as the basis for payment of
benefits.
Contract: An agreement
between your employer and your insurance
carrier that typically describes the
benefits of your dental plan.
Copayment: The part of
the fee you owe the endodontist after your
insurance carrier has paid its portion.
Coverage: The benefits
available to you under your 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 the
insurance carrier will allow your benefit
plan to pay the endodontist.
EOB: Identifies the
benefits (the amount your insurance carrier
is willing to pay) and charges covered and
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
for paying 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: A term used by
insurance companies to describe the amount
they are willing to pay for a particular
endodontic procedure.
