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With indemnity dental plans, the insurance company generally pays the dentist a percentage of the cost of services. Restrictions may include the co-payment requirements, waiting period, stated deductible, annual limitations, graduated percentage scales based on the type of procedure, and the length of time that the policy has been owned.
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 amount that is paid by the insurance is known as an "allowed amount". [19] For example, although a psychiatrist may charge $80.00 for a medication management session, the insurance may only allow $50.00, and so a $30.00 reduction (known as a "provider write off" or "contractual adjustment") would be assessed.
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A guaranteed maximum price (also known as GMP, not-to-exceed price, NTE, or NTX) contract is a cost-type contract (also known as an open-book contract) such that the contractor is compensated for actual costs incurred plus a fixed fee, which is limited to a maximum price. The contractor is responsible for cost overruns greater than the ...
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This can be seen as the "walk away" point for either party, in negotiation where the reservation price is the point beyond which a negotiator is ready to walk away from a negotiated agreement. [3] A seller may produce a reservation demand , which is a schedule of reservation prices at which a seller would be willing to sell different quantities ...
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 ...