INBDE (Integrated National Board Dental Examination) Practice Exam

Dental plan that allows the dentist to charge the patient any difference between what the plan agrees to pay and the dentist's UCR fees is called?

1. Direct reimbursement

2. Capitation

3. Indemnity

4. Balance billing

The correct answer is: Balance billing

In a dental plan where the dentist is allowed to charge the patient the difference between what the insurance plan agrees to pay and the dentist's Usual, Customary, and Reasonable (UCR) fees, it is referred to as "balance billing." This practice enables the dentist to bill the patient for any remaining amount not covered by the insurance plan. Option A, Direct reimbursement, refers to a method where the dentist is reimbursed directly by the patient for the services rendered, with the patient later seeking reimbursement from their insurance plan, if applicable. Option B, Capitation, involves a fixed monthly fee paid by the patient to the dentist or the dental practice, regardless of the services provided. This model often includes a set range of covered services. Option C, Indemnity, is a traditional fee-for-service insurance plan where patients can choose their preferred dentist, and the plan will pay a portion of the fees for covered services. Patients may be responsible for the remaining balance after insurance coverage.