Blue Cross / Blue Shield PPO Dual Coverage
If you are fortunate enough to have Blue Cross / Blue Shield PPO dental insurance and an additional dental insurance policy, this can greatly reduce your out of pocket expense for dental care. Sunnyvale Dentist Dr. Antonious is a Blue Cross / Blue Shield PPO (Preferred Provider Organization) in network dentist. Utilizing the services of an in network provider is another way to lower your out of pocket dental cost.
The front office staff at Sunnyvale Dental Care will be happy to contact Blue Cross / Blue Shield PPO dental insurance and your additional plan to help you understand how the two companies will work together to pay your dental claims. This is called coordination of benefits.
The plan provided by your employer is generally your primary dental insurance. Dental insurance plans provided from other sources are considered secondary insurance. For children covered by both parents’ insurance policies, the birthday rule applies. The parent whose birthday occurs first in the year (month and day) will provide the primary coverage. The other parent would provide secondary coverage.
Dual coverage works the same whether you have two plans by Blue Cross / Blue Shield PPO or one plan from Blue Cross / Blue Shield PPO and one from another carrier. The amount paid by both plans will not exceed the amount submitted on the insurance claim.
In non-duplication coordination of benefits, if the primary and secondary insurance both cover root canal therapy at 80%, after the primary plan pays its 80%, the secondary plan will pay nothing. Standard coordination of benefits is much more favorable to you the patient. Under this scenario if the primary dental insurance covered the root canal at 80% the secondary insurance would pay the remaining 20% and you would have no out of pocket cost. It is important to read the fine print when purchasing dental insurance.
After Sunnyvale Dentist Dr. Antonious completes your dental treatment, the insurance coordinator at Sunnyvale Dental Care will submit your claim to your primary insurance first. After the primary insurance has paid its portion, the secondary insurance claim will be submitted. In many cases, patients who have not reached their annual maximum have little to no out of pocket cost.