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Know Your Coverage Part 1: 10 Common Dental Insurance Terms Explained

October 16, 2018.TruAssure.0 Likes.0 Comments

Know Your Coverage Part 1: 10 Common Dental Insurance Terms Explained

You might have heard these words and phrases before, but if you aren’t sure what they mean, you could be misunderstanding what your dental benefits plan covers. Brush up on your dental insurance knowledge to ensure you’re ready to make informed decisions next time you come across these terms

1. Claim: A form requesting payment that is sent to your benefits carrier by you or your dentist after a procedure based on your benefits plan. In-network dental offices usually submit them for you, but you might have to send the form yourself if you seek care from an out-of-network dentist.1

2. Claim appeal: If your benefits carrier rejects a claim, you have the opportunity to state your case as to why the procedure should be covered. This takes the form of a “claim appeal” that your dentist will send to the benefits carrier.2

3. Co-insurance: The percentage of the cost for a dental procedure that you’re responsible for paying. The remaining balance is covered by your benefits carrier after you’ve reached your deductible.3

4. Deductible: The amount you’re responsible for paying each year before coverage begins, which will differ depending on your plan.4

5. Explanation of benefits (EOB): A summary sent by your benefits carrier detailing the services you received, procedure costs and the amount covered by your plan. It is sent for informational purposes only and is not a bill.

6. Lifetime deductible: The amount you pay before coverage begins. You’ll only pay a lifetime deductible once for the plan’s duration rather than on an annual basis like a regular deductible. TruAssure’s Choice and Choice Plus plans offer lifetime deductibles.

7. Policy: Documentation you receive either electronically or by mail that details what your dental plan covers.

8. Pre-determination of benefits: If a procedure is expected to cost more than $200, you can ask your dentist to submit a pre-determination of benefits to your benefits carrier. This will provide you with an estimate for how much of the cost will be covered and what you’ll likely be required to pay.5

9. Premium: The amount you pay each month to maintain your dental benefits plan.

10. Waiting period: The time between when a plan starts and when it begins covering dental care services. Most dental plans have a waiting period for basic and major services. TruAssure’s Choice and Choice Plus plans don’t have any waiting periods.

1 https://www.truassure.com/faq
2 https://dentalclaimsupport.com/appealing-dental-claims/
3 https://truassureblog.com/breaking-truassure-member-benefits/
4 https://truassureblog.com/breaking-truassure-member-benefits/
5 https://truassureblog.com/wp-content/uploads/2017/06/TA_PredeterminationDC-2.pdf

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