Some patients have two dental insurance policies to help offset their dental treatment cost. Perhaps that is your situation. You may have a Guardian 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 family members. This is called dual coverage. Sunnyvale Dentist Dr. Gupta is a Guardian PPO Dental insurance preferred provider. If you have dual coverage, the insurance coordinator at Sunnyvale Dental Care will submit your dental claims to each insurance carrier for you. How are dental claims processed when a patient has dual coverage?
Coordination of Benefits
Coordination of benefits is the term used to describe how multiple insurance companies work together to pay for their members covered services. This ensures that the amount paid by both insurance carriers does not exceed the amount submitted on the dental claim.There are two types of coordination of benefits: standard and non-duplication. In standard coordination of benefits if a crown is covered by Guardian PPO Dental at 60% as the primary insurance, the secondary insurance would pay the other 40%. A non-duplication of benefits plan is less ideal. If the Guardian PPO Dental primary insurance 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, and the balance would be billed to the patient.
The Sunnyvale Dental Care insurance coordinator cannot choose which policy to bill first and which to bill second. 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 two family members, generally the birthday rule applies. The family member with the birthday that occurs first in the calendar year would provide primary coverage and the other insurance subscriber would provide secondary coverage.
Sunnyvale Dentist Dr. Gupta will have his insurance coordinator contact both insurance carriers to verify how they will coordinate the payment of your dental claims. They will first submit your dental claim to the primary dental insurance. Afterwards, when the primary insurance pays their portion, the secondary insurance can be billed. Once both insurance plans pay on the claims, hopefully you will have little or no remaining balance for you to pay.