Maximizing Dental Coverage: The Role of Secondary Insurance

Dental Billing
Outsourcing Dental Billing Vs. In-House Dental Billing
April 25, 2024
Insurance Verification
What is the Difference Between Insurance Verification and Prior Authorization?
May 3, 2024
Secondary Insurance

A patient can be covered by more than a single dental insurance plan, leading to what is known as dual dental coverage. This occurs when a patient has access to two different dental insurance plans, perhaps through their employment or a spouse’s plan, thus providing additional coverage.

One insurance plan is designated as the primary insurance, and the other acts as the secondary insurance. Understanding how secondary insurance functions and maximizing coverage benefits from multiple insurance plans are crucial for both patients and dental practices. Accurate billing and the avoidance of dental billing errors are essential to prevent claim denials.

It is vital for a practice to have a deep understanding of primary and secondary insurance dynamics. The claim with the secondary insurance plan must be filed after the primary insurance claim. Determining which insurance plan is secondary is crucial and requires careful consideration of factors such as enrollment dates, birth dates, or coverage duration. Dental software often facilitates this process by allowing claims to be marked as primary or secondary.

Secondary insurance serves to provide additional benefits for treatments not covered by the primary plan or when treatment costs exceed the primary plan’s maximum coverage limit. Initially, claims are submitted to the primary insurer. Upon receiving payment, a claim, accompanied by the primary insurer’s Explanation of Benefits (EOB), is sent to the secondary insurer to cover the remaining balance.

It’s important to note that secondary insurance supplements, rather than replaces, primary dental insurance by covering additional service costs not included in the primary plan. Not all insurance plans offer secondary coverage options.

How Secondary Insurance Works

  • Coverage Limits: Primary dental plans have annual maximum coverage limits. Once these limits are reached, additional costs must be covered out-of-pocket or through secondary dental insurance.
  • Covered Services: Primary plans typically cover preventative care and complex procedures, like crowns or root canals. A secondary plan may cover the remaining costs of services not fully covered by the primary plan.
  • Coordination of Benefits: This process ensures that the dental practice receives payment from the primary insurer first, with the secondary plan covering any remaining balance, based on the coverage limits.
  • Co-payments and Deductibles: These may be part of secondary insurance plans.
  • Premiums: The primary dental plan is usually employer-paid, while secondary insurance might come with an additional premium, paid by the individual or provided through another employer or a spouse.
  • Provider Network: Primary plans often have a specific network of providers, whereas secondary plans may offer a broader selection or allow for any licensed dentist’s services.

Obtaining secondary dental insurance through employment or directly from insurance organizations requires careful consideration of the costs and benefits. The value of paying premiums for two insurance plans is justified when it significantly reduces out-of-pocket expenses.