How Does Secondary Dental Insurance Work?

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A common question arises among dental professionals: How does secondary dental insurance work if patients have two or more dental benefit plans? Secondary dental insurance kicks in after the primary dental insurance has contributed its share. The cash flow of the dental office depends on accurately and compliantly submitting claims.

In this article, Capline Dental Services, a trusted dental billing company, explains how secondary dental insurance works. Accepting multiple insurance plans can broaden the patient base and secure reimbursements for earned income.

What is Coordination of Benefits (COB)?

To grasp how secondary dental insurance functions, it’s essential first to understand the Coordination of Benefits. This process is the starting point for filing claims for patients with multiple insurance plans, identifying one as primary and the other as secondary. The primary plan is where the patient is the main policyholder or is enrolled through employment. The dependent’s plan becomes the secondary plan.

How Does Secondary Dental Insurance Work?

Understanding that secondary dental insurance is the plan that provides coverage after the primary plan has paid its claim might seem straightforward. However, dental practices often struggle to determine which plan is primary and which is secondary.

Several factors influence the determination of secondary dental insurance, including birthdays, dates of enrollment, length of coverage, and whether the insurance is yours or your spouse’s.
The rules of COB are straightforward, and for any questions, contacting the insurance companies for clarification on primary and secondary statuses is advisable.

Examples of Secondary Dental Insurance

Consider two spouses, each with individual insurance plans, who enroll in each other’s insurance policies. The insurance plan through their respective jobs is considered primary, and the spouse’s plan is secondary, following the Spousal Coverage rule.

For parents to ensure their child is fully covered by dental insurance, determining the primary and secondary policies can be challenging. For example, a child covered under both parents’ insurance plans must have a clearly identified primary and secondary policy. The primary insurance is determined by the birthday rule, meaning the parent whose birthday comes first in the calendar year is the primary policyholder for the child. This rule does not necessarily refer to the oldest parent but to whose birthday occurs earliest in the year.

If both parents share the same birthday, the policyholder with the longer duration of coverage becomes the primary insurer. Understanding which policy is primary and secondary is vital for correct claim processing and maximizing the child’s benefits from both policies.

Things to Remember About Secondary Dental Insurance

  • Having two insurance policies does not guarantee full coverage for the rendered service. The secondary policy covers expenses not included by the primary policy.
  • Claims for dental expenses are typically first submitted to the primary insurer, which reviews the claim and pays its portion according to the policy. The primary insurer then issues an Explanation of Benefits (EOB), detailing the payment amount, reasons for any denied charges, and any remaining balance owed.
  • The claim is then forwarded to the secondary insurer for additional review and payment. The secondary insurer pays its share of the expenses up to the policy limits. After payment, the policyholder receives another EOB outlining the payment and any remaining balance due.