Can you switch primary and secondary insurance? - Capline Dental Services

Can you switch primary and secondary insurance?

What are the forms used for Dental billing?
May 7, 2021
How do I bill an out of network claim?
May 12, 2021

Many individuals have more than one healthcare insurance plan as they are covered under an employer-based plan while also being covered via spouse’s plan. Being covered under two health insurances can be a real benefit while submitting claims as it can enhance the coverage amount allowing a person to save more money on their dental insurance costs. When a person has primary and secondary insurance that means primary insurance pays first for medical bills while secondary insurance pays only after the amount paid by primary insurance doesn’t meet the entire cost. Generally, secondary insurance pays for some or all the remaining amount. In such cases, a person finds secondary insurance useful in lowering their dental care payments depending upon how much amount the primary insurance provider provides. In case, if primary insurance denies paying for the dental care claims, then secondary insurance may or may not pay the same or rest of the cost depending upon the coverage plan.

Know about switching between primary and secondary insurance:

It is possible to change between primary and secondary insurance and for that, an individual who wants to stop the coverage of his/her primary insurance just needs to inform their secondary insurance about it. They should also tell their secondary insurance provider that from now on they will use their secondary insurance as the primary one. However, it is advisable to check for some rules to preserve the integrity of information. 

Listed below are some of the steps to switch secondary insurance to primary one:

  1. Firstly visit the patient’s Insurance Information page by clicking on “patient” and then on “Insurance Information”, now choose the primary plan.
  2. Next step is to enter the date on which primary insurance coverage is ending. After entering the date in the Coverage End field save it by clicking on save.
  3. Now, choose the secondary insurance plan and end it as well by clicking on the coverage end date as you performed in the previous step. After this step, your secondary insurance will also end.
  4. In this step, you need to click on add plan, and here search for a new insurance plan and choose primary in coverage type. After this choose the coverage start date and day. In most cases it is the next day to when the primary coverage ended on the last plan.

What does Coordination of Benefits mean?

When an individual is covered under two insurance plans and gets health claims payout for both the insurance plans then this process is known as Coordination of Benefits. A general example of coordination of benefits is when someone’s partner has a family health insurance plan and they are able to maximize their health care coverage. In simple words, when a person has both primary and secondary insurance plans then, they can avail coordination of benefits. The primary insurance plan needs to pay first for dental care services then the rest amount will be paid by secondary insurance as per the coverage.

Why keep both health insurance plans?

If a person has excess to two health insurance plans then it is the best way to save money spent on health insurance as some amount will be paid by the primary one and the rest will be paid by the secondary one. However, there are certain rules made to avoid some frauds like a person can’t get paid for medical claims that are duplicated for the same injury or disease. Thus, the total amounts will not be paid by both insurances.

What are the conditions in which a person will be covered under both insurance plans?

Check out these examples to know in which conditions the person is covered under both plans:

  • Children whose parents are covered by two health insurance plans may get coverage in both plans in case the parents took the family plan and decided to provide benefits of both plans to their children.
  • Adult children whose age is less than 26 years also get coverage from their school or college or from their parents.
  • Married couples who have health insurance plans provided by their employer are also covered by two or more health insurance plans.

Any individual who has more than one insurance plan should always discuss it with their insurance providers about the coordination of benefits and how it will benefit them for a better understanding of health insurance coverage. Additionally, every insurance plan provides different benefits so double check in case of kids to decide if the kids are covered under such insurance or not.

This doc is just telling us how billing proceeds if patient’s have dual insurance coverage, It is not mentioned whether the primary or secondary can be switched with each other or not, If yes then what are the conditions and guidelines.

In Non Duplicate clause – If patients have dual coverage, then it is not mandatory to bill the primary first, we can either bill it to primary or secondary one.

Google Rating
4.9
Based on 70 reviews