If you are fortunate enough to have Cigna PPO dental insurance coverage and additional coverage under another insurance plan, this can greatly reduce your out of pocket cost for dental care. Sunnyvale Dentist Dr. Gupta is a Cigna PPO (Preferred Provider Organization) provider.
You may have a Cigna PPO plan through your job and additional coverage through your spouse. Children are sometimes covered under both parents’ plans. Primary and secondary insurance policies coordinate to cover your dental claims. This is called coordination of benefits. Dual coverage works the same whether you have two Cigna PPO plans, or plans from Cigna PPO and another carrier. The amount paid by both plans will not exceed the amount charged by Dr. Antonius.
In standard coordination of benefits if you have a filling that is covered at 60% by the primary insurance company, the secondary insurance company would pay the 40% that you would have had to pay if covered by only one plan. Some plans have a non-duplication of benefits rule. Under this rule if both plans cover fillings at 60% and the primary plan has paid its 60%, the secondary plan would not make any additional payments.
Unfortunately you cannot decide which policy to use as primary and which to use as secondary. This is determined by the insurance companies. The insurance coordinator at Sunnyvale Dental Care will be happy to contact Cigna PPO and any additional insurance company to verify how each insurance company will be covering your claims.
Generally, the dental insurance that you receive through your employer is your primary insurance. If you have coverage from two employers, the insurance company that you’ve been with the longest would be considered your primary insurer. Coverage from any source other than your employer would be secondary insurance. For children who have Cigna PPO coverage through one parent and an additional plan through the other parent, the parent whose birthday occurs first in the year (month and day) provides primary coverage.
The insurance coordinator at Sunnyvale Dental Care will submit all dental claims for you. Once your primary insurance company pays their portion of your claim it will then be submitted to your secondary insurance company. Most patients with dual coverage who have not reached their annual maximum have minimal, and sometimes no out of pocket expense for dental treatment. Receiving treatment from a Cigna PPO Provider like Sunnyvale Dentist Dr. Gupta will also reduce your out of pocket cost. This is because PPO providers follow the Cigna PPO fee schedule which has fees that are lower than standard dental fees.