Dental insurance has many rules and regulations, and that makes the thing confusing for many dental professionals. If the patient has dual coverage, the dental practices can sometimes be unsure of how the secondary dental insurance works and how to file it. Capline Dental Services is a trusted dental insurance billing and collection company that can
help dental teams submit secondary claims for quick payments.
In the article, Capline maps out how accepting secondary dental insurance can increase the pool of patients, but if not submitted correctly, can delay the payment.
Secondary dental insurance is dependent upon the coordination of benefits. As the term suggests, COB is the order of filing dental insurance claims of patients with multiple plans. It is a list to refer to for different situations. The rules and regulations under COB can get challenging, and that is where trusting a third party like Capline to submit claims can help with quicker reimbursements.
To understand how secondary dental insurance works, first, we need to understand what is secondary dental insurance. Patients have multiple dental insurance plans, out of which one is primary and one is secondary. The primary plan will get billed first, and then the secondary insurance. The primary plan covers the maximum part of the claim, and the secondary works as the supplemental plan.
Sometimes, the patient has even more than two plans, especially patients with children. For instance, if both parents have individual primary and secondary plans, in that case, the child is covered under all four plans.
In the case of multiple insurance plans, secondary insurance is the insurance plan that gets filed later. It seems very simple, but dental professionals struggle to determine which plan is secondary. The secondary plan depends on several factors, such as patient insurance vs. spouse's insurance, birthdays, dates of enrollment, and length of coverage of the plan.
Here are some methods to determine which plan is primary and which is secondary:
The adult beneficiary is the subscriber on both plans- where the plan with the earliest effective date is primary.
The patient is dependent on one and the subscriber on another- the dependent plan is secondary, and the subscriber plan is primary.
If the beneficiary is a federal employee- the beneficiary's medical plan is primary, whereas the dental plan is secondary. The rule applies to the spouses of federal employees if they do not have
their coverage.
If the child patient lives in a two-parent household- in this scenario, the birthday rule applies where the parent with the earliest birthday month is primary. If both parents have the same month, the parent with the earlier day is the primary.
The patient with their dental coverage and the spouse of the federal employee- the patient's plan is primary, their spouse's federal medical plan is secondary, and the spouse's federal dental plan is tertiary.
The child's patient parents live apart- the plan of the parent the child lives with is the primary plan.
The child patient lives with the parent and the step-parent- the plan of the biological parent with whom the child lives is the primary, and the other parent's plan is secondary. The step-parent's coverage is third for the child patient.
Secondary dental insurance gets billed after the primary EOB (Explanation of benefits). Dental practices should check the filing deadline to avoid delays or rejections.
Some dental plans have non-duplication of benefits. That brings more complexity to the dental billing process. Non-duplication of benefits clause means if they are secondary plan, they will not pay more benefits than the primary coverage.
For instance, for coordination of benefits, if the primary pays 80% of the treatment, the secondary insurance will pay the remaining 20%. For non-duplication of benefits, the primary pays 80% of the treatment, and the secondary pays 0%.
Secondary dental insurance work can cause a struggle in the billing process, and therefore, consider partnering with Capline Dental Services to pay quickly and correctly.
