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Dentistry in / False and II) Date: to the include am will Multiple True / False, Fill-in-the-Blank, and Short Answer questions. Here are Sample A: Multiple True / False some examples of these formats: (the following stem would serve for all the questi 6. courseFillin-the-blank question 5. below,taken in theSteve Levy 4. Has four in-class exams False in (no calculators 3. Can beon guest hourof Preferred Provider 2. FeaturesPractice mornings 1. Is3directed by lecturesyear insteadeachtheOrganizations (PPOs). so Meetstwo-creditDr.ofD2orby differentofCommunity II (111:161): onsyouawouldThursdayTrueDentistry forthepeopleD3 yearwill be allowed in the exam List characteristics class Sample B: Fill-in-the-blank The 3. 2. 1. C: answer question) ) Mrs. Anderson has a dental insurance plan with an annual cap of $1000, an annual $250, and a of deductible patient copayment of 20% for all procedures. Assuming she has not us dental ed any services this year, how much will the INSURANCE COMPANY contribute toward payment of a procedure that costs $500? (you must show your work to get full cre dit) D: Short answerof the Article X that was assigned as a required reading? (Ans Whats Sample the main point question 1-2 full wer with sentences. If you dont use full sentences you wont receive credit for you r answer.) showExam: Posted on ICON there will be material on this sample exam This is to Sample Midterm question types only; covered have midterm exam is get worked harder of the that youyetThenotyear, so dontusually the up about that.two exams in this cours GOOD NEWS! this so e, for most students it gets easier from here on out . . .

The course study for the exam Material tohandouts provide a lot of potential test material, so this guide shou study. focus your ld helpFor each slide that presents a chart, table, or figure, just come up with points; its very likely that if I ask anything about that slide it will be about t 1-3 take-home home points that hose same take- you generated yourself. In general, look for the most . . . the least . highest . . . the in general a trend is going up, down or staying the same . . whether foretc. If I ask you it will be something like About how many people . . . or Abo . specific numbers, percentage of the population . . . and I wont ask for petty, arcane stuff, Ill ask ut what important issues that I would hope at this stage youd be able to tell are importa about big Video: 27 concentratePrivateHealth Carematerial: . Slide this to theInsurance CoverageSystem (Caplan): you should(Public of Rates Among Nonelderly)U.S.) differs in other countries (v nt. ForSick exam and theHealthin Unemployment) International Comparisons the following the Introduction Around U.S.World: Care Expenditures) Specific (Impact theon RiseHealth care(Caplan): 5 examples 32 (Uninsured 30 (Health as to in health in delivery how This lecture presented Medical important concepts and / Patient . show that you . the 13 (How do Insurers)of Expenditures) s.SlideU.S.) to Dental Insurance (Caplan): 30 (Dentistyoull need.to . HMO) Introduction 32 (Percent of lots through Slide them. Make sure you understand how to do Sample C above, since one or more quest understand relate to ions will those topics. Also see the next page for a translation of indemnity, PPO All the 6 (Explanation DentalFinancial Assistance) presentations (so . SlideInsurance Examples (Caplan): for the above are referring to NOT to concepts. (DentalPlans BetweenBenefits and Dental Coverage) , and DHMO(Differences (Schooley):whatknowPlan Type)numbers are referringthe require Dental 8 (PaymentBenefitsBenefits) Required Readings know 3 22 (SourcesDetail) = Billings) the numbers 19 (Commercial Grossassigned by what the of of Medical . d Take-home messages and big picture Medicaidonly group sessions): readings from the Health Care Reform and numbers small

Introduction to Dentalpayer, the dentist delivers aIndemnity, PPO, DHMO Without a third-party Insurance: Translation of service to the patient, and reimburses the patienttheof managed care (e.g., indemnity, PPO, DHMO) the patient chooses t With any kind dentist. some kind of o enroll in dental insurance plan (or not), usually through their work site. Th usually is e premium paid to the insurance company by the employer on behalf of the patien decides the patient t, i.e.,whether to sign up for the plan; if they do, the employer deducts the am premium from ount of the the employees paycheck and sends that amount to the insurance compan . Additionally: y.If the dentist does not accept Assignment of Benefits, it means that the patient completes the insurance paperwork and sends it to the insurance company; the pat responsible for paying the dentist the full amount charged; and the insurance co ient is . If reimburses the patient for the amount the insurance company is that the dentist mpanythe dentist does accept Assignment of Benefits, it meanssupposed to pay. com company the patients paperwork directly for the amount theyre supposed to pay. Patients pletes pays the dentistand sends it to the insurance company; then the insurance this because then they only have to pay for their amount, not the total amount. With indemnity insurance, the insurance company sets a fee for every dental proc like price is sometimes less than a dentist would charge for that procedure). The den edure (this whatever he/she wants for any procedure, and expects to receive the entire amoun tist charges the insurance t charged fromcompany and/or patient. In contrast to the PPO (described below), discount there is noon the fees -- its just a matter of who is supposed to pay the dentists fee . Dentists can choose whether to sign up with the PPO (they would be panel dentists network) or in theor not sign up with the PPO. If the dentist signs up with the PPO, he/sh that the fee e is agreeingset by the insurance company is the fee he/she will accept as paymen that procedure, t in full for REGARDLESS of what his/her usual charge is -- and he/she cannot amount any collectover that allowed fee from the patient. For example: Suppose a dentists us for a 1-surface amalgam is $100; the PPOs allowable fee for a 1-surface amalgam i ual charge there and s $85;is no deductible, copayment, annual cap, or anything like that for which t . patient is responsible. heIf the patient goes to a dentist who is not signed up with the PPO, the insura would pay $85 nce company and the patient would need to pay the additional $15. The dentist thus wouldreceive their $100 fee. This is much like indemnity insurance (described ab . If ove).the patient goes to a dentist who is signed up with the PPO (i.e., a panel insurance company would pay $85 and the patient would not need to pay anything. dentist), the dentist would thus receive $85 total for that service. This is why patients migh The to visit preferred providers because IF the dentist charges more for the service t t prefer the han insurance company allows, the patient is not responsible for the difference. With a Staff Model HMO, the dentist is an employee of the insurance company and salary from receives a them. In this model, fees are paid on a capitation basis (i.e., some per enrollee, regardless of whether any services are delivered). The other model amount per month above are fee-for-service (i.e., fees are charged only if services are delivered s described ).