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The world of dental insurance vocabulary

Dental insurance can be a confusing topic for both patients and dental professionals. However, it is crucial for a dental team to have a thorough understanding of dental insurance terminology and how insurance works.

This not only helps the team provide accurate information to patients but also facilitates clear communication between the dental office and insurance companies. When the dental team is knowledgeable about insurance policies and procedures, they are better equipped to answer patient questions and help them navigate the complexities of their coverage. This can result in a smoother and more stress-free experience for patients, as well as improved financial outcomes for the dental practice. Ultimately, having a well-informed dental team benefits everyone involved, and demonstrates a commitment to patient satisfaction and quality care.

  • Annual maximum - The highest dollar amount that an insurance plan will cover in a given year.

  • Benefit period - The length of time during which an insurance plan will cover a specific procedure or treatment.

  • Claims process - The steps taken by an insurance company to review and pay out a request for coverage.

  • Co-insurance - The amount that a patient is required to pay for a covered service, typically a percentage of the total cost.

  • Deductible - The amount that a patient must pay out-of-pocket before their insurance begins to cover treatment costs.

  • Exclusions - Procedures or treatments that are not covered by an insurance plan.

  • In-network provider - A healthcare provider who has a contract with an insurance company to provide services at a discounted rate.

  • Maximum benefit - The highest dollar amount that an insurance plan will cover for a specific procedure or treatment.

  • Out-of-network provider - A healthcare provider who does not have a contract with an insurance company to provide services at a discounted rate.

  • Out-of-pocket maximum - The maximum amount that a patient is required to pay for covered services in a given year, after which the insurance company will cover all additional costs.

  • Pre-authorization - The process of obtaining approval from an insurance company before a specific procedure or treatment is performed.

  • Preventive care - Dental care that is intended to prevent the onset of disease or other oral health problems.

  • Procedure code - A code used to identify a specific dental procedure or treatment.

  • Provider - A healthcare professional or facility that provides medical or dental care.

  • Waiting period - The length of time that must pass before an insurance plan will cover a specific procedure or treatment.

  • Annual deductible - The amount that a patient must pay out-of-pocket for covered services in a given year before their insurance begins to cover treatment costs.

  • Capitation - A type of payment plan in which a healthcare provider is paid a fixed amount per patient per month, regardless of the number or type of services provided.

  • Co-payment - A fixed amount that a patient is required to pay for a covered service at the time of treatment.

  • Coordination of benefits - A process in which multiple insurance policies are used to cover the costs of a single treatment or procedure

  • Covered services - Procedures or treatments that are included in an insurance plan.

  • Dependent - A family member who is covered by another person's insurance policy.

  • EOB - An Explanation of Benefits, a document that outlines the details of a claim and the amount of coverage provided by an insurance plan.

  • Expiration date - The date on which an insurance policy or coverage period ends.

  • Flexible spending account (FSA) - A type of account that allows a patient to set aside money from their paychecks on a pre-tax basis to cover out-of-pocket healthcare expenses.


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