Common Insurance Terms
White Family Dentistry, Gregory R. White, D.D.S. - Common Insurance Terms
Insurance Company: A company that administers and adjudicates benefits according to the plan picked by the employer. They front the money for payment and the employer reimburses. If the employer is unable they are insured by the State and will be reimbursed by the State of Minnesota for funds lost.
PPO: Preferred Provider Organization (NOT an insurance company); Insurance companies contract with PPOs so that they can utilize their network of providers. However, a PPO never determines what is covered or how it is covered. They only determine if the provider used is part of their network. If the provider is a part of their network they will adjust the fees according to their contract with the provider.
DMO: Dental Management Organization; Patient must pick a specific dental provider. If the patient goes to any other provider, no benefits will be paid.
TPA: Third Party Administrator (self-funded); These are companies who adjudicate claims and payment on behalf of the employer. They are not an insurance company and are not bound by the insurance laws or insurance commissioner. These plans are funded directly from the employer. NOTE: An insurance company (e.g. MetLife) can also have self-funded plans but a TPA can not have insured plans because of licensing differences.
DED - Deductible