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A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.

Any condition that a patient has before enrolling in a new health insurance plan.

Occurs when a provider bills a patient for the difference between the provider's charge and the amount covered by the patient's insurance.

A dental or medical procedure that is not essential for the patient's health, often cosmetic in nature, and typically not covered by insurance.

A payment arrangement for health care service providers such as dentists, where they are paid a set amount for each enrolled patient assigned to them, whether or not that person seeks care.

The amount of time an insured individual must wait before some or all of their coverage comes into effect.

A group of dental providers who have contracted with an insurance company to provide services at pre-negotiated rates and terms.

A request for your health insurer or plan to review a decision that denies a benefit or payment (either in whole or in part).

The maximum amount a dental insurance plan will pay toward the cost of dental care within a specific period, usually one year.

Dental procedures that are not covered by an insurance plan. Patients are fully responsible for the cost of these services.

A statement from the insurance company detailing what was covered for a medical or dental service, and what the patient is responsible for paying.

Specific conditions or circumstances for which the policy will not provide coverage.

The portion of a dental care bill that the patient must pay out of pocket at the time of service.

The percentage of the cost of a dental service that the patient is responsible for paying after the deductible is met.

A form submitted to a dental insurance company that lists the treatments performed, billing codes, and charges, in order to process payment.

A self-funded dental insurance plan where the employer or another entity directly reimburses employees for dental services they receive, regardless of where they receive them.

A managed care plan where services are covered only if you go to dentists or specialists in the plan's network (except in an emergency).

Dental procedures that are related to evaluating or maintaining a patient's oral health, such as cleanings, routine exams, and X-rays.

The span of time during which a health insurance plan will pay for covered healthcare services. Typically a year.

A specified amount of money that the insured must pay before an insurance company will pay a claim.

A set of health care procedure codes based on the American Medical Association's CPT codes. It includes codes not covered in CPT, such as ambulance services and prosthetic devices, and is used by Medicare and other health insurance programs.

A type of managed care dental insurance plan in which a dentist receives a monthly fee from the insurance company for each patient on a list assigned to him or her, regardless of whether or not services were rendered.

A type of health plan where patients pay less if they use providers in the plan's network. Patients can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

UCR refers to the amount paid for a dental service in a geographic area based on what providers in the area usually charge for the same or similar dental procedure.

The most an insured patient will pay during a policy period (usually a year) for dental care before the insurance plan begins to pay 100% of the allowed amount.

A medical classification system for coding diseases, signs and symptoms, abnormal findings, and external causes of injury or disease. Used in dentistry for recording diagnoses and conditions.

Dental care that is required for a patient's health and well-being, as opposed to elective or cosmetic treatment.

American Medical Association's standardized numeric system for reporting medical procedures and services for billing purposes. In dentistry, used primarily for procedures related to oral surgery or when billing medical insurance for dental procedures.

A pre-approval for treatment where the dentist submits a treatment plan to the insurer to determine the amount of coverage before the treatment is carried out.