Question

What is this: a contractual agreement signed by a policyholder, which enables a third party to file an insurance claim, make repair decisions, and directly bill an insurer on the policyholder's behalf; when pts come in to be established pts, they sign and get payments sent directly to dental practice, end up asking pt for a certain % of the cost since their insurance only pays so much/the balance

a) Copayment
b) Deductible
c) Coordination of Benefits
d) Assignment of Benefits

Answer 1

The agreement is known as Assignment of Benefits, which entails a third party billing an insurer directly. Patients are responsible for the balance not covered by insurance, which can include deductibles, copayments, or coinsurance.

Step-by-step explanation:

The contractual agreement described in the question, where a third-party can file an insurance claim, make repair decisions, and bill an insurer directly on behalf of a policyholder, is known as Assignment of Benefits. This allows payments for services like dental treatments to be sent directly to the dental practice. The amount covered by insurance may not always be the full cost, so the patient is responsible for paying the remaining balance, which could include deductibles, copayments, or coinsurance. These are cost-sharing arrangements that require the policyholder to pay some expenses out-of-pocket, thereby reducing moral hazard and ensuring that the insured party is also financially responsible for a portion of the costs incurred.