However, it may reduce out-of-pocket expenses depending on treatment diagnosed by a dentist. Dual coverage works the same way whether a patient is covered by two dental plans that are the same or two entirely different dental insurance companies. You will notice many insurance companies do in fact work together to coordinate your patient's benefits. So, which plan pays first?? The chicken, or the egg? We are only kidding For real though, the dental insurance plans set forth rules to determine which plan pays first, "primary" and which plan pays afterward "secondary".
The general rule is that the plan that covers the patient as an enrollee is the primary plan and the plan which covers the patient as a dependent is the secondary plan. For a child's coverage, generally, the primary insurance company is determined by the birthday rule i. A divorce agreement or other court ruling may supersede the birthday rule.
Better safe than sorry to ask for this if you have a divorce or court situation especially you pedo and ortho offices that see way more of this How dual coverage works. For example, if both of your patient's plans provide two cleanings a year, each with 80 percent coverage, then:. Your patient would not be entitled to four cleanings a year.
Your patient may want to argue this but we promise we are right here The primary plan pays its benefit as if there is no other insurance.
Ok, we know some of you are about to send an email right now because you have seen BOTH insurances pay the max amount of the prophy on a single visit. Your office knowingly accepting this is insurance fraud. You need to do the right thing, call the insurance, and request the process of a recoupment. A simple audit can be done and the insurance company will request it anyways.
Do not hold on to it, the headache of them recouping it on their own accord by subtracting from another patient's insurance payment is NOT worth it. What does Non-duplication of benefits clause mean? Some dental benefit plans have "non-duplication of benefits" provisions.
Learn how supplemental dental insurance can support your medical or dental plan. Americans with dental benefits are more likely to go to the dentist, take their children to the dentist, receive restorative care, and even experience greater overall health.
Dissatisfied with your current level of coverage? Getting individual dental insurance directly from an insurance provider might be a good place to start. How much does dental insurance cost? Ready to purchase a high-quality dental insurance policy to supplement or replace your current plan?
Get a free online dental insurance quote. Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.
This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office. Join our new digital insurance community that includes tips, resources and useful information from Guardian Direct.
All Articles Dental Insurance. What is secondary dental insurance? Looking for plans? Free Quote. Insights for the people. Email address. If you need expensive dental work, such as implants or bridges , the cost can typically exceed an annual limitation on benefits. Having a supplemental dental plan can help alleviate the financial burden by covering all or part of the charges that exceed the allowed maximum of your dental insurance plan. Another advantage of having a supplemental dental insurance plan is to provide benefits for services that your current plan may not cover, called restrictions or exclusions.
For example, if your current plan does not cover adult braces orthodontics , you can find a supplemental plan that specifically covers braces for adults. You can typically use the supplemental plan, in conjunction with your primary dental insurance, to help pay for your orthodontic care.
If you have a dental insurance plan through your employer or have purchased an individual plan, that plan is known as your primary plan. Whenever you have any dental treatment done, you or your dental provider sends a claim to your primary plan. Depending on the details of the plan, the primary plan typically pays for all or part of the charges.
If the primary plan pays only a part of the charges, then your supplemental dental insurance plan can help cover either all or part of the remaining balance of your dental bill provided it is an approved dental service.
Supplemental plans will not accept a claim until after the primary plan has paid the claim. This is known as coordination of benefits COB. Dental insurance purchased as a supplemental plan typically provides specific amounts of coverage for a variety of dental services, similarly to a primary plan. It is important to understand the services covered—for example preventive, restorative, major, endodontics, surgery, orthodontics— and the amount of the benefits before signing up for a supplemental plan.
The best supplemental dental insurance plan is the one that fits the needs of you, your family, and your budget. Are there waiting periods? Are the deductibles and copays high, meaning you will have to pay a lot out of your own pocket?
Does the plan have restrictions such as no coverage to replace pre-existing missing teeth or no orthodontic coverage? If your children or you want to get braces, the best supplemental dental insurance plan may be one that has orthodontic coverage. Perhaps you have a great medical insurance plan, but it does not include any provisions for dental care. The supplemental dental insurance plan that may work for you will be one that has comprehensive coverage to address yours and your family needs.
Senior citizens face unique challenges in seeking coverage for dental services. While Medicare may provide coverage for hospitalizations and most out-patient medical services, only certain Medicare plans provide benefits for dental care.
Purchasing individual dental insurance is an option for seniors who may have lost dental benefits once they retired. Having a way to help defray the costs for dental services can be especially helpful since you may be on a fixed income. If you need extensive dental work e. Waiting periods for coverage is another time when having a supplemental plan could help.
Some dental policies have waiting periods of a year or more for certain services. Dual coverage usually happens when two spouses or partners both have dental benefits through their employer.
If you find this to be the case, you can either compare the costs of premiums, co-pays, deductibles, and coverage options to choose just one employer-sponsored plan to cover your whole family, or keep both policies and enjoy the advantages of dual coverage. The plan that you have at your job is considered the primary plan.
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