Nowadays, many patients have two dental insurance policies to help offset their dental treatment cost. Perhaps that is true for your family. You may have a First Dental Health 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 two sources. This is called dual coverage.
Sunnyvale Dentist Dr. Gupta is a First Dental Health PPO Dental preferred provider. If you have dual coverage, the insurance coordinator at Sunnyvale Dental Care will submit your dental claims to each insurance carrier. How are dental claims processed when a patient has dual coverage?
Coordination of Benefits
Coordination of benefits is the term used to describe how primary and secondary insurance work together to pay for their members covered dental treatment. The combined amount paid by primary and secondary insurance carriers will not exceed the amount charged by the provider dentist.
The two types of coordination of benefits are standard and non-duplication. A non-duplication of benefits plan offers less coverage. If the primary insurance plan and the secondary insurance plan both pay for fillings at 80%, after the primary claim is paid, the secondary insurance would not pay the additional 20% owing on the bill.
If given an option, it is better to choose a dental insurance plan with standard coordination of benefits. Under this type of coordination, if a crown is covered by First Dental Health PPO at 60% as the primary insurance, the secondary insurance would pay the other 40%.
The Sunnyvale Dental Care insurance coordinator cannot choose the order in which to bill the primary and secondary insurance. This decision is made by the insurance companies. In most cases the insurance plan provided by your employer will be your primary insurance plan. For children with dental insurance provided from two sources, 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 coordinator contact First Dental Health PPO insurance and the additional insurance carrier for you 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, a secondary claim will be sent out. After each insurance company has paid their portions, hopefully you will have little or no out of pocket cost.
Learn more when you visit Sunnyvale Dental Care. Call Sunnyvale Dentist Dr. Gupta at 408-720-0900 to schedule a consultation today!