Dental Insurance Terminology

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Across
  1. 2. Approval required before certain services are rendered
  2. 4. Providers not contracted with the plan
  3. 5. Request for reconsideration after a claim denial
  4. 6. Providers contracted with the insurance plan
  5. 8. Explanation of Benefits – outlines what was paid or denied
  6. 9. Change to a balance due to a contract or insurance write-off
  7. 12. Service A procedure the insurance does not pay for at all
  8. 13. Date Date the dental insurance coverage begins
  9. 14. Limitation Limit on how often a procedure is covered
  10. 16. Date Date the dental insurance coverage ends
  11. 18. A request for payment submitted to insurance
  12. 19. The person who holds the dental policy
  13. 20. Number Identifier that connects a plan to an employer or organization
  14. 21. Date The date used to decide which plan is primary in dual coverage
  15. 24. Stands for Usual, Customary, and Reasonable
  16. 27. Amount Maximum dollar amount insurance will consider for a procedure
  17. 28. ID Unique number used to identify the primary policyholder
  18. 30. Fixed dollar amount paid by the patient at time of service
Down
  1. 1. Period Time required before certain benefits can be used
  2. 2. Estimate of benefits before treatment is completed
  3. 3. Max The most a patient will pay during the plan year
  4. 7. A person covered under the policy but not the main policyholder
  5. 10. Schedule List of maximum amounts a plan will pay for each procedure
  6. 11. Amount the patient must pay before insurance pays
  7. 15. Tooth Clause Policy exclusion if tooth was missing before coverage started
  8. 17. The insurance plan that pays first
  9. 18. of Benefits Rule that determines which plan pays first when dual coverage exists
  10. 22. Patient’s percentage of the cost after insurance pays
  11. 23. Coverage When a patient has two dental insurance plans
  12. 25. Insurance refusal to pay for a submitted claim
  13. 26. The insurance plan that pays after the primary
  14. 29. Confirmation that a patient has active coverage