As far as dental insurance is concerned, it’s fine to have one policy—you might be surprised to learn you can have two. If you’re asking yourself, “Can you have 2 dental plans?” or “How does secondary dental insurance work?”, you’re among the majority. Knowing how secondary dental insurance works can help you save money. It also highlights the importance of accurate dental insurance verification to ensure claims are processed smoothly and maximum benefits are received.
In this blog, we’ll explain what secondary dental insurance is, how it will work with your primary dental insurance, and whether having two dental insurance policies is a good option for you.
What Is Secondary Dental Insurance?
Secondary dental insurance is a backup plan aimed at helping limit your out-of-pocket dental expenses by covering amounts not paid by your main dental insurance. Not many are familiar with the method of secondary coverage, but it can prove a useful means for maximizing your dental benefits and guaranteeing thorough protection.
That is, secondary dental insurance is an umbrella coverage. After your primary dental insurance settles your claim and pays your share of the cost, a secondary policy comes into play to pay for the cost remaining. How much coverage secondary insurance pays is determined by policy conditions and limits of coverage.
How Secondary Dental Insurance Works
When you have two dental coverages, the primary insurance will pay first. Once the primary insurance company pays the claim, the remaining costs, such as co-pays, deductibles, or uncovered procedures—are passed on to your secondary dental insurance. Depending on the coordination guidelines between your two insurance companies, the secondary plan can help pay these additional costs.
It’s important to understand that although secondary dental plans will pay for the balance, they generally won’t pay you more than 100% of the dental treatment. This is Coordination of Benefits (COB), and it’s designed to make both dental insurance verification companies work together so that they can pay as much of your dental bill as possible without both of them paying out more than the value of the care.
When do I bill the secondary insurance?
Knowing when to bill secondary dental insurance is crucial so your dental claims are handled correctly and you get the most out of your coverage. You typically bill secondary dental insurance after your primary dental insurance has paid its portion of the claim. This is what you do:
File with Primary Insurance
Then, file your dental claim with your primary dental insurance. They will pay out their share and inform you of how much they will cover.
Get Primary Payment
Once the primary insurance has been paid, you will get an Explanation of Benefits (EOB) from them. It states what was paid and what is left to be covered.
File with Secondary Insurance
After you have obtained your primary insurer’s EOB, you can file the claim with your secondary dental insurance. Partnering with outsourcing dental insurance verification specialists can help dental practices manage dual insurance claims without delays. Your plan will pay the balance remaining within its terms.
Coordinate Benefits
Your secondary dental plan will coordinate benefits with your primary coverage so that you receive no more than 100% reimbursement, as regulated by rules for Coordination of Benefits (COB).
It’s critical to do things in the correct sequence so that both plans accurately represent your dental expenses. Many dental providers partner with dental insurance verification companies to ensure faster, error-free claim filing and reimbursement. Knowing when to bill secondary dental insurance will save you time and allow you to take advantage of your benefits.
Key Difference Between Primary And Secondary Insurance
Feature | Primary Dental Insurance | Secondary Dental Insurance |
|---|---|---|
| Order of Payment | Pays first | Pays after primary processes |
| Coverage Responsibility | Main coverage | Supplemental coverage |
| Claim Filing | Filed first | Filed after primary EOB |
| Purpose | Covers basic dental costs | Covers remaining balances |
| Coordination | Initiates claim | Coordinates to avoid overpayment |
Initiates claim and works with insurance verification services to coordinate between primary and secondary insurers.
How do I know which is my primary insurance?
If you carry two dental insurance policies, make sure to distinguish between which policy is your primary dental insurance and which is your secondary dental insurance. Your primary plan pays first, and your secondary plan covers any additional charges based on the rules of coordination of benefits.
4 Easy Steps to Identify Your Primary Insurance
Your Own Plan Is First
If you do have a dental insurance policy through your employer, it’s your first one.
Spouse’s Plan Is Second
In case you have coverage under your spouse’s policy as well, your spouse’s policy typically remains your second one.
The Birthday Rule for Dependent
For dependents covered by two dental plans, the parent with a birthday earlier in the calendar year will usually be the primary insurance provider.
Active Employment vs Retired
In the case where you have an active employer’s plan and one from a prior (retired) employer, the active employer’s plan will be the primary dental insurance.
If you ever need to be sure, your insurance companies or your dental provider can confirm it for you when they coordinate benefits between your secondary and primary dental plans.
Knowing how secondary dental insurance works and your primary dental insurance helps you have easy claim processing and enjoy fully benefiting from having two dental insurance policies.
How do dual dental coverage and COB work?
When you have two dental insurance policies — usually referred to as dual dental coverage — you can potentially save money and receive wider benefits. But to prevent double payments, insurance companies apply a system known as Coordination of Benefits (COB).
Here’s How Dual Dental Insurance Works
Primary Dental Insurance Pays First
Your primary dental insurance pays your dental claim first. It pays based on its policy conditions.
Secondary Dental Insurance Pays Next
Once the primary plan has processed the claim and issued the Explanation of Benefits (EOB), your secondary dental insurance takes over. The secondary plan can pay for any remaining eligible expenses such as co-pays, deductibles, or non-covered services — subject to the provisions of your secondary dental plan.
No Overpayments Permitted
With COB rules, you cannot be paid more than 100% of the cost of your dental care. The secondary insurance will only cover up to the balance not paid by the primary plan.
Having two dental coverages and fully comprehending how secondary dental insurance operates can greatly lower your out-of-pocket costs and optimize your benefits. Proper coordination often involves efficient dental insurance claims management to avoid billing errors or coverage denials. Always notify your dentist of both insurance policies to ensure claims are billed appropriately.
Benefits of Having Two Dental Insurance Plans
Having two dental insurance policies, also referred to as dual dental coverage, can be a wise means of optimizing your dental benefits while keeping your out-of-pocket expenses to a minimum. Here is how having primary and secondary dental insurance can work in your favor.
Benefit | Details |
Reduced Out-of-Pocket Costs | Your main dental insurance pays the initial fees, and your secondary dental insurance pays the balance, reducing or removing costs such as co-pays, deductibles, and uncovered services. |
More Comprehensive Coverage | Some procedures not fully covered by one plan may be partially or even fully covered by your secondary dental plan, assisting you in better dental care. |
Backup Protection | Even if your first dental insurance denies a claim, your second policy may assist by covering some or all of the bill, providing added financial safeguarding. |
Higher Annual Maximum Benefits | You could have an increased combined yearly benefit limit by purchasing two policies of dental insurance, enabling you to have more procedures completed annually. |
Better Access to Providers | Having dual dental coverage could provide you with access to a larger group of dentists, depending on the various plans that you have. |
Peace of Mind | Having a secondary dental insurance plan in addition to your regular dental plan offers additional protection against unforeseen dental costs, and this makes you feel more secure. |
Limitations and Considerations
While two dental insurance policies may bring numerous advantages, there are significant restrictions and factors you should note.
Limitation | Details |
No Double Payment | As a result of Coordination of Benefits (COB) regulations, you are not reimbursed more than 100% of the cost of treatment even with primary and secondary dental insurance. |
Various Coverage Rules | Each policy can have varying coverage limits, waiting periods, and excluded procedures, which may influence the extent to which the secondary dental insurance pays. |
More Complicated Billing Process | It takes careful monitoring to file claims with two carriers. You first bill your primary dental insurance, wait for the Explanation of Benefits (EOB), and then bill your secondary dental plan. |
Increased Premium Fees | Having two dental plans can translate to paying more premiums, so one must consider the cost versus the benefit. |
Coordination Issues | There are insurance companies with rigid COB practices that cap the amount the secondary dental insurance will pay based on the primary dental insurance’s payment. |
Plan Types Count | Not all dental plans arrange benefits similarly. Some secondary dental plans have a “non-duplication of benefits” rule, which means they won’t pay if the primary already reimbursed the normal allowed amount. |
Tips for Managing Dual Dental Insurance
Notify Your Dental Office
Always inform your dentist that you hold two dental insurance policies. This informs them to properly submit claims to their primary and secondary dental insurance.
Learn Coordination of Benefits (COB)
Educate yourself on how COB functions so that claims are billed in the proper order to avoid delayed or rejected claims.
Review Both Dental Plans
Understand what your main dental insurance pays first and what your secondary dental plan can pay second to avoid surprise expenses.
Track Claims and EOBs
Keep all copies of filed claims and Explanation of Benefits (EOBs) handy to remain organized and handle any problems speedily.
Check for Waiting Periods
Certain secondary dental insurance policies have waiting periods for significant services. Take note of these prior to scheduling treatments.
Ask About Non-Duplication Rules
Certain secondary dental policies have non-duplication of benefits rules, which means they might not pay if the primary dental insurance has already paid for the service.
Compare Premium Charges against Value
Ensure that the total premium for two dental insurance plans is worth the additional coverage you’re getting.
Smartly Plan Treatments
Schedule costly treatments after knowing how both your main and secondary dental insurance will treat the claims.
How QuestSol Verifies Primary and Secondary Dental Insurance
We make dental insurance verification easy, quick, and accurate at QuestSol. Our skilled staff carefully verifies your primary dental insurance as well as secondary dental insurance to ensure seamless claim processing. We first verify the patient’s eligibility, plan, and benefits with the primary dental insurance company. After verification, we then call the secondary dental insurance company to determine the rules of coordination of benefits (COB), waiting periods, and coverage limits.
Our expert verification procedure determines which is primary and secondary insurance by industry standard and patient-specific information. We mark all verification information in plain detail and refresh your practice management system so that your billing staff has a clear understanding of how to file claims correctly in order. This reduces denials of claims, accelerates payment, and ensures that patients get maximum benefit from their insurance without ambiguity.
At QuestSol, we specialize in the management of complicated dual insurance cases to ensure that verification and claims become easy for patients and dental practices.
FAQs About Dental Insurance Verification
Yes, it is possible to have two dental insurance policies simultaneously, usually through a combination of your own company's plan and a spouse's or parent's plan.
Dual dental coverage occurs when you are insured under two dental insurance policies simultaneously, which can reduce your out-of-pocket expenditures.
If you have two dental plans, the first dental insurance pays out, and the second dental insurance can cover remaining eligible expenses based on the coordination of benefits (COB) rules.
COB is how dental insurance companies determine which plan to pay first and how much the second dental insurance will pay.
No, two dental insurance policies cannot cost more than the treatment itself. You will not be reimbursed twice for the same procedure.
Pros are lower costs and greater coverage. Cons are more complex billing and possibly higher premium fees.
Yes, you can have both a dental discount plan and a dental insurance policy, but you typically cannot use them together for the same service on the same visit.
Usually, your primary plan is your employer's plan, and your secondary plan is a spouse's or parent's plan. Children have special rules under both parents' plans.
Secondary dental insurance pays for costs not covered completely by your primary insurance, including co-pays, deductibles, or uncovered services.
The secondary dental plan covers after the primary dental insurance has sent the Explanation of Benefits (EOB) for remaining eligible charges.
Yes, it can pay for out-of-pocket expenses such as deductibles, co-pays, and even sometimes for services not fully covered by the primary plan.
Dental providers can streamline claim processing for primary and secondary insurance by working with dental insurance verification companies or outsourcing dental insurance verification services. These partners assist in verifying coverage details and coordinating claims filing to maximize reimbursements.
Submit the claim to your primary dental insurance first. Once they process it and send you an EOB, submit that EOB along with your bill to your secondary dental insurance.
An EOB indicates what your primary dental coverage paid. It's needed by the secondary insurance to pay their share of the claim.
Yes, you can have two dental plans from two different dental insurance companies, and they will coordinate benefits based on COB rules.
Yes. Certain services may still be excluded, and rules of non-duplication of benefits could reduce the secondary dental insurance payment.
Select the best secondary dental insurance by comparing premiums, coverage, waiting periods, and how well it covers gaps left by your primary dental insurance.
Compare the costs versus the benefits, review the plans' rules, and see how coordination of benefits operates between them.
Some states have specific rules that impact how primary and secondary dental insurance coordinate benefits, so it's important to check local regulations.