The Howlin Building
10085 Dunkirk Way, #202
Dunkirk, MD 20754

301-855-6008 · 410-257-2400
Fax: 410-257-0628

Q: Can you provide some explanations of insurance terminology?

A: Insurance jargon can make understanding one's dental benefits difficult. Misunderstanding your policy can affect getting the most of the benefits, which you have, available to you. Listed below are some types of dental plans and definitions of insurance terminology. Direct Reimbursement - Enables employers to offer cost-effective dental benefits while allowing employees the freedom to choose their own dentist. Patient is reimbursed directly by the employer.

Indemnity or Fee for Service - This coverage allows patients to choose their own dentist and any specialist. Fees are set according to the level of coverage purchased by the employer. The insurance company does not get to decide whether the visit was necessary.

Preferred Provider Organization (PPO) - A dentist who contracts with an insurance company to provide care at discount fees. One can refer themselves to specialists without getting approval, as long as it is with an in-network provider. This program will allow a patient to go to a non-participating dentist, however the reimbursement for services will be substantially reduced.

Fee for Service - Allows the patient to choose any dentist. Coverage with this feature allows the patient to receive full benefits for treatment provided by any dentist of their choice.

Limitations - Limits the benefits for procedures or the number of times a procedure can be covered.

UCR - Usual, Customary, Reasonable

Usual - The fee that an individual dentist most frequently charges for a given dental service.

Customary - A fee determined the insurance company based on a range of usual fees charged by the dentist in the same geographical area.

Reasonable - A fee that is justifiable considering special circumstances of the particular care rendered.