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first you should obtain the explanantion of benefits from your primary. it should indicate what the write off amount is. if you're not sure, call the insurance company and ask them. then do the same with your secondary. the secondary insurance will consider the amount allowed by the primary and will usually base their benefits on that. if you are lucky, between the two, you should have little out of pocket expenses.
What else can I help you with?
Can you be covered by delta dental and aetna dental at the same time?
Yes, you can be covered by multiple dental policies. There will be one insurance carrier as your primary insurance and the second insurance carrier will be your secondary insurance.
Can a dental office bill a secondary insurance company after the primary HMO lists the service as no charge?
Why not? What are the terms of the 2nd Insurance?
What is primary and secondary dental insurance?
If a husband and wife both have dental insurance through their employers, the employee's insurance is primary when the employee is the patient, and it must pay it's benefits. The spouse's insurance is secondary, and will only pay once the primary insurance has paid. Depending on how the policy is written, sometimes the secondary insurance will pay any residual fees up to the annual maximum. Sometimes the secondary insurance only pays if their fee schedule allows higher fees than the primary insurance. This assumes that each spouse is named as a dependent on each other's policy. Ask the insurance coordinator at your dental office to what benefits are available between the two policies.
What does Carve out coordination of benefits mean in dental insurance?
When a patient has primary and secondary insurance plans and there is a CO Bcarve out clause on their secondary plan this is what happens. Primary pays their amount and secondary subtracts primary's payment from what they were suppose to pay and pays the difference. Example: Primary pays 50% of a filling which cost $100.00 and secondary pays 80%. Primary pays $50.00, secondary would pay $80.00, therefore, secondary would only pay $30.00 of the remaining $50.00. It is a very confusing issue and I have been in dental for over 25 years and I still have a hard time explaining this to patients.
If your dental office participates with a patients secondary dental insurance do you still have to write off anything?
Yes. By your contract with the secondary insurance you are required to write-off the discount
What if your husbands dental insurance doesn't cover crowns and you can get dental insurance through your company does he have to drop you from his?
Absolutely not. However your husbands policy would become your secondary insurance and you would hold your own primary insurance. Make sure you check with each insurance company to verify that the offer coordination of benefits on what is considered major work!
How do dental secondary claims get paid. What is the process?
You wait until the primary claim is paid then send a copy of the payment along with the secondary claim form. The insurance company will figure out what is left to pay and send you a check.
Is it required to make a primary dental insurance adjustment if the dentist is a preferred provider before submitting a claim to secondary insurance?
You wait until both claims are received then write off the lesser of the two amounts
Do the primary dental insurance rules govern the allowed charges from the dentist?
The answer to the question, is it depends. State laws on coordination of benefits (CoB) can impact the answer, but there is a general rule of thumb. If the dentist participates in a network that is connected to the patient's coverage--whether that coverage is primary or secondary, the participating network contractual relationship determines the amount that can be collected from the patient.Here's a table that was developed by the National Association of Dental Plans outlining various CoB scenarios and what determines the charges to patients under each.PATIENT COVERAGEWHAT THE DENTIST CHARGES THE PATIENTPrimary and secondary coverage are both DPPOs; Office participates in both network plans.The DPPO allowances of the primary plan.Primary coverage is a DPPO, and the secondary coverage is an indemnity plan.The DPPO allowances of the primary plan.Indemnity plan is primary, and the secondary coverage is a DPPO.The DPPO allowances of the secondary plan. Primary coverage is an DHMO, and the secondary is an indemnity plan.The DHMO patient co-payments. (The secondary indemnity plan may cover all or most of these co-payments.)Indemnity plan is primary, and the secondary coverage is an DHMO.The DHMO patient co-payments. (The primary indemnity plan may cover all or most of these co-payments.)Primary coverage is a DPPO, and an DHMO is the secondary plan.The DPPO allowances of the primary plan.Primary coverage is an DHMO, and the DPPO is the secondary plan.The DHMO patient co-payments. (The secondary DPPO plan may cover all or most of these co-payments.)NOTE: Discount dental plans are not subject to COB laws and regulations as they are not insurance products.
You have maxed out your insurance for the year where can you find secondary dental plan?
To find companies in your state that provide dental insurance or dental discount plans, go to the National Association of Dental Plans site (www.nadp.org) which has a directory of companies that offer dental insurance. The directory can be searched by state and you can select "individual" and get the list of just those companies that provide individual dental insurance in your state. The listing also tells you if the company provides dental HMO, dental PPO, dental indemnity (traditional insurance without a network) or a discount plan (not insurance but a discount off the dentist's fees who are part of the discount network).
How do you determine a child's primary dental insurance when both parents have different dental insurance?
Each state has rules governing which policy is primary and which is secondary. If the parents are together, most states use the birthday rule. That means the birthday of the parent that comes earliest in the year. If the parents are separated, it will be the parent with custody unless a court order says otherwise. Your insurer will know the answer for your state or Che k with your insurance department--they usually have a consumer advocate you can check with.
My husband has dental insurance through his work and so do I but who is primary?
That depends on how the policies are written. Some policies state that when there are two dental insurances, the employee is primary and the dependent is secondary. Other policies state that the person whose birthday falls first in the year is primary. Your best option is to either discuss this issue with your Human Resources department at work or discuss it with the individual who handles insurance claims at your dentist's office. ***Birthday rule only applies to covered children of a married or cohabiting couple. If the parents live in separate households, custody rule or divorce decrees override the birthday rule. The policyholder will be the primary carrier if both policies are full-time employment policies. If one of the policies is retirement coverage, the retirement coverage would be secondary. In your case, your insurance is primary for you and your husband's insurance is primary for him.
