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Some dental insurance plans may have an annual maximum benefit limit. Once the annual maximum benefit is exhausted any additional treatments may become the patient's responsibility. Each year, the annual maximum is reissued. The reissue date may vary as a calendar year, company fiscal year, or date of enrollment based on the specific plan.
For dentists, the American Dental Association defines a usual and customary fee as "the fee an individual dentist most frequently charges for a specific dental procedure independent of any contractual agreement. It is always appropriate to modify the fee based on the nature and severity of the condition being treated and by any medical or ...
The Target Fee varies between the Minimum Fee and the Maximum Fee according to a formula tied to the Actual Cost (e.g. Target Fee could be 10% of the Actual Cost). Sharing Ratio : the agreed upon cost sharing proportion, normally expressed in percentage (e.g. 85% for the client / 15% for the contractor).
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Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. [ 1 ] In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care.
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In insurance, the insurance policy is a contract (generally a standard form contract) between the insurer and the policyholder, which determines the claims which the insurer is legally required to pay. In exchange for an initial payment, known as the premium, the insurer promises to pay for loss caused by perils covered under the policy language.
Before negotiating a total loss settlement with your insurance company, arm yourself with knowledge by independently determining the value of your vehicle. Your vehicle’s value will depend on ...
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