Some patients have two dental insurance policies to help offset their dental treatment cost. Perhaps that is true of you. You may have an Aetna PPO Dental Insurance policy through your employer and another plan through your spouse or an additional job. Some children are covered by dental insurance plans from each parent. This is called dual coverage. Sunnyvale Dentist Dr. Gupta is an Aetna PPO Dental preferred provider. If you have dual coverage, the insurance coordinator at Sunnyvale Dental Care will submit your dental claims to both insurance carriers. How are dental claims processed when a patient has dual coverage?
Coordination of BenefitsCoordination of benefits is the term used to describe how primary and secondary insurance work together to pay for covered services. This ensures that the amount paid by both insurance carriers does not exceed the amount charged by the provider dentist.
There are two types of coordination of benefits: standard and non-duplication. In standard coordination of benefits if a crown is covered by Aetna PPO Dental at 60% as the primary insurance, the secondary insurance would pay the other 40%. A non-duplication of benefits plan differs in coverage. If the Aetna PPO Dental primary plan and the secondary insurance plan both pay for fillings at 80%, after the primary claim is paid, the secondary insurance would refuse to pay the additional 20% owing on the bill.
The Sunnyvale Dental Care insurance coordinator cannot choose which policy to bill as primary insurance and which to bill as secondary insurance. This is decided by the insurance companies. In most cases the insurance plan provided by your employer will be your primary insurance plan. For children covered by both parents, generally the birthday rule applies. The parent with the birthday that occurs first in the calendar year would provide primary coverage and the other parent would provide secondary coverage.
Sunnyvale Dentist Dr. Gupta will have his insurance team contact both insurance carriers to verify how they will coordinate your benefits. They will submit your dental claim to the primary dental insurance first. Once the primary insurance pays their portion, the secondary insurance can then be billed. After both insurance plans pay their portions, hopefully you will have little or no out of pocket cost.