Insurance term
Frequency Limitation
Definition
A frequency limitation is a plan rule that limits how often a procedure is covered, such as two cleanings per year or one set of bitewings per year.
Why it matters for the front desk
Frequency limits are one of the most common reasons for denials on routine care. The wording matters: "twice per calendar year", "once every six months" and "once per 12 months" each give different eligible dates. Visits at other offices count too. Recording the last date of service for exams, cleanings and x-rays during verification lets the team schedule recalls on a date the plan will pay for.
Related reading
Blog
A Plain English Glossary of Dental Insurance Terms
Related terms
- Eligibility Verification Eligibility verification is the process of confirming, before an appointment, that a patient's dental coverage is active and what it will pay for.
- Waiting Period A waiting period is the length of time a patient must be enrolled in a plan before certain services are covered.
- Annual Maximum The annual maximum is the most a dental plan will pay toward a patient's care in one benefit year.