A list of covered services with an assigned dollar amount that represents the total obligation of the plan with respect to payment for such service, but does not necessarily represent the dentist’s full fee for that service.
Any contractual arrangement where payment or reimbursement and/or utilization are controlled by a third party. The term “managed care” refers to a cost containment system that directs the utilization of health benefits by: a.) restricting the type, level and frequency of treatment; b.) limiting the access to care; and c.) controlling the level of reimbursement for services.