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Glossary

  1. D

    Deductible
    A flat amount the member must pay before the insurer will make any benefit payments.
    dental health maintenance organization (DHMO)

    An organization that provides dental services through a network of providers to its members in exchange for some form of prepayment. For all of your dental questions and/or claim forms, please contact your local Blue Cross and Blue Shield company.

    dental point of service (dental POS) option

    A dental service plan that allows a member to use either a DHMO network dentist or to seek care from a dentist not in the HMO network. Members choose in-network care or out-of-network care at the time they make their dental appointment and usually incur higher out-of-pocket costs for out-of-network care. For all of your dental questions and/or claim forms, please contact your local Blue Cross and Blue Shield company.

    dental PPO

    See dental preferred provider organization. For all of your dental questions and/or claim forms, please contact your local Blue Cross and Blue Shield company.

    dental preferred provider organization (dental PPO)

    An organization that provides dental care to its members through a network of dentists who offer discounted fees to the plan members. For all of your dental questions and/or claim forms, please contact your local Blue Cross and Blue Shield company.

    DHMO

    See dental health maintenance organization. For all of your dental questions and/or claim forms, please contact your local Blue Cross and Blue Shield company.

    Direct Care Provider
    An individual or organization that offers care directly to the member. The direct care provider is in the same physical location as the member and offers care to patients from within the local Plan's service area Some examples are: (1) a provider who physically examines the patient, (2) a lab that performs the blood draw from a patient, or (3) a technician who fits a prosthetic limb to the patient. The direct care provider should file claims to the local Blue Plan.
    disease management
    A coordinated system of preventive, diagnostic and therapeutic measures intended to provide cost-effective, quality healthcare for a patient population who have or are at risk for a specific chronic illness or medical condition. Also known as disease state management.
    disease state management
    See disease management.
    drug utilization review (DUR)
    A review program that evaluates whether drugs are being used safely, effectively, and appropriately.