Author Topic: Stupid question about dental insurance (benefits)  (Read 2826 times)

lifejoy

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Stupid question about dental insurance (benefits)
« on: May 02, 2016, 08:56:26 AM »
Hi!

I used my work insurance 4 months ago to get a cleaning and check-up. I don't know if they did the level of work that I'd like. Recently I was added to my husband's insurance. I have not claimed a dental cleaning and check-up with my husband's insurance. If I claim one now, even though I'm not due for a cleaning for two months, will that count as cleaning #1 with DH's insurance, and thus be covered?

Not sure how all of this works... thanks for your help! I hope this makes sense.

MonkeyJenga

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Re: Stupid question about dental insurance (benefits)
« Reply #1 on: May 02, 2016, 11:09:11 AM »
I recommend calling your new insurer directly and asking them. Whatever answer you get, document it along with the date time, and name of the person you speak with. If they can email you a confirmation, even better.

catccc

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Re: Stupid question about dental insurance (benefits)
« Reply #2 on: May 02, 2016, 01:04:28 PM »
IDK how they know, but I'm told with dual coverage, you don't get to cash in on 4 cleanings/year.  They'll submit to your primary, then your secondary.  And you don't get to decide which is primary.  This is a bum deal.  I was considering paying out of pocket for a different insurance than I get through my employer so my dentist would in network.  I haven't actually tried it, but the outlook isn't promising.

lifejoy

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Re: Stupid question about dental insurance (benefits)
« Reply #3 on: May 03, 2016, 06:52:59 AM »
Good advice! Thanks!

Le Dérisoire

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Re: Stupid question about dental insurance (benefits)
« Reply #4 on: May 03, 2016, 07:03:38 AM »
There is only one good answer to your question and it’s "ask your insurer".

No one here knows the specifics of your particular contract. They are often similar from place to place, but not identical.

frugaliknowit

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Re: Stupid question about dental insurance (benefits)
« Reply #5 on: May 03, 2016, 10:11:51 AM »
You might want to consider not using your hard earned money for "dual insurance" (assuming it does cost you).

In fact, you might want to consider self insuring on dental, paying the premiums into a savings account.  Without employer subsidies, dental insurance is basically "smoke and mirrors" (a budgeting tool at best).

catccc

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Re: Stupid question about dental insurance (benefits)
« Reply #6 on: May 06, 2016, 07:27:56 PM »
Just wanted to add that my dual insurance (2nd plan premiums paid OOP) looks like it will pan out and save me $$.  The coverage is about the same, but the billing people at my dentist's office tell me that since they are in network for my secondary insurance, I'll see write offs instead of balance billing.  Fingers crossed that this works out!

Tom Bri

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Re: Stupid question about dental insurance (benefits)
« Reply #7 on: May 06, 2016, 09:15:40 PM »
Just wanted to add that my dual insurance (2nd plan premiums paid OOP) looks like it will pan out and save me $$.  The coverage is about the same, but the billing people at my dentist's office tell me that since they are in network for my secondary insurance, I'll see write offs instead of balance billing.  Fingers crossed that this works out!

Up until about two months ago, I worked for a dental insurance company, in claims. Basically, the advice others gave above is accurate. One thing though, If your insurance is through your work, that plan automatically becomes the primary plan for you, and your spouse's plan is secondary (unless your insurance company has REALLY odd coordination of benefits rules.)

So the way it normally works, your dentist sends the claim to your plan, gets a response, and then forwards that response and the claim to the secondary. The secondary will normally pay on what is left over.

Where it gets tricky is the IN network and OUT of network rules. Normally, the secondary pays as Out of network, again unless they have odd rules in their contract that allows them to pay as In-network. So, in spite of what your dentist tells you, there is a good chance it will be balance billing, unless he agrees to write off the difference. Many dentist office workers have NO IDEA how insurance works, so they just bill you whatever the insurance company tells them to.