Dental insurance, on its own, can prove to be challenging enough to decipher. Therefore, when two different coverages are thrown into the mix it can become even more complex and hard to understand. In order to facilitate your efforts, there are a few rules of thumb that should be followed for better treatment estimates and finalize the patient portion, thus making your job easier.
What it doesn’t mean, is that the patient has double the coverage. But the good news is that it usually indicates a lower out of pocket expense for the patient.
Suggest a cost parison for premiums, deductibles, copays, etc. when a patient asks about adding a second plan. The benefit may not be worth the cost in some cases, but in others a slam dunk. Be sure to read the fine print on both of the dental policies to see which services each one covers or if there are any waiting periods and how the benefits will be coordinated.
The primary carrier will pay first, the secondary carrier will pay second only after the primary carrier contributes. The general rule is that the plan that covers you as an enrollee is the primary plan and the plan that covers you as a dependent is the secondary plan. If the enrollee has two plans through current employment at two jobs, then the plan that has been in effect the longest is usually the primary.
The general rule is that the plan that covers you as an enrollee is the primary plan and the plan that covers you as a dependent is the secondary plan. If the enrollee has two plans through current employment at two jobs, then the plan that has been in effect the longest is usually the primary.
The purpose of establishing an order of benefits right away is to avoid processing delays and prevent overpayment, which can cause bigger headaches in the long run. In most instances, dental plans coordinate benefits - this means the primary plan will pay the claim as it normally would, and the secondary plan will pay what is left based on its coverage limits and up to 100 percent of the total claim. However, a secondary plan with a non-duplication-of-benefits rule reduces what would have been paid by what the primary plan has already paid, thus leaving an out-of-pocket expense for the patient. The only difference to this rule is if a plan has a no-coordination-of-benefits clause, meaning it does not coordinate benefits, will automatically be considered primary, and special rules are used to designate the order.
-The birthday rule is used if the patient is a dependent on both plans – the policy of the subscriber with the earlier birth date in the year is primary. EX: Mom DOB: October 7, 1977 Dad DOB: December 14, 1970 – In this scenario the Mom would be the primary insurance holder because October comes before December.
-If a patient has 2 policies through the same company, you will only need to submit one claim. The insurance company, in most instances, will process the primary and secondary together.
-The primary carrier pays its normal benefit and any calculation or adjustment of benefit is done by the secondary carrier.
-The secondary carrier will almost always require that an EOB from the primary insurance company be included with the claim submission.
Taking the time to learn and understand the details of how dual insurance and the coordination of benefits works will surely alleviate insurance issues within the office. Not to mention, having a front office team that can help the patients with such knowledge and precision is just one more thing that adds value to your practice and will make you stand out.
