Supplemental dental insurance
July 12, 2013 4:10 PM Subscribe
How to get more insurance when you already have insurance through your employer.
I have employer dental insurance. It it not that great. How can I get more insurance? Is it legal to have two polices and use both? So if my current insurance covers 50% of something, would the supplemental cover the other 50%? How does this work?
I have employer dental insurance. It it not that great. How can I get more insurance? Is it legal to have two polices and use both? So if my current insurance covers 50% of something, would the supplemental cover the other 50%? How does this work?
Man, it's a pain in the ass. You can absolutely stack dental insurance IF your provider accepts both forms of insurance.
Then what happens is that they will process through whatever your primary will take, see what the balance is, and pass that on to the secondary to see what they'll take. Typically this means 50% of what's LEFT, not of the total meaning you go free. But that will vary dramatically based on the plan rules.
Your dentist's billing department will have experience with secondary insurance, since it's a very common thing, but it again will be of no value to you if you don't confirm that both are accepted.
If you know you need a specific treatment, you'll want to make sure that the procedures are covered under both, that there isn't a waiting period for the new one, that the co-pay is well understood, and that the maximum allowed yearly benefit for both makes it make sense.
Dental insurance is kind of silly that way: it has a maximum benefit amount for a calendar year, instead of a minimum deductible to hit and THEN the insurance kicks in, like most insurance plans have.
They will also characterize treatments as major or minor and may pay out different percentages for each. I had crowns done which was major and my primary insurance at the time only covered 25%.
Also, both policies may be able to be in your name, but it can also be weird sometimes, since there may be a bit of a fight to determine who is the primary. (No one wants to be the primary, since they'd pay more.)
My wife's dental insurance is better through her work so I'm on that because my teeth hate me, but I also doubled up and kept mine through my own company, which is worse insurance. But because I'm the policy named-insured on my company's, that's the primary and the secondary cleans up whatever's left. 20% of 80% is the same as 80% of 20%, so it doesn't matter to me but it usually results in a weird flurry of inaccurate "THIS IS NOT A BILL BUT YOU MAY OWE" notices and then even bills that I ignore until they turn pink and only then do I call to figure out what's missing.
Insurance is confusing, inconsistent, difficult, poorly-documented, poorly-understood, variable, and a quagmire. The way that your dentist codes something can cause significant changes in what they're able to charge for a procedure, what they're able to get back from the insurance, and how both of your providers pay out, so don't be surprised if you just knock your own teeth out to save yourself the trouble.
posted by disillusioned at 4:32 PM on July 12, 2013 [1 favorite]
Then what happens is that they will process through whatever your primary will take, see what the balance is, and pass that on to the secondary to see what they'll take. Typically this means 50% of what's LEFT, not of the total meaning you go free. But that will vary dramatically based on the plan rules.
Your dentist's billing department will have experience with secondary insurance, since it's a very common thing, but it again will be of no value to you if you don't confirm that both are accepted.
If you know you need a specific treatment, you'll want to make sure that the procedures are covered under both, that there isn't a waiting period for the new one, that the co-pay is well understood, and that the maximum allowed yearly benefit for both makes it make sense.
Dental insurance is kind of silly that way: it has a maximum benefit amount for a calendar year, instead of a minimum deductible to hit and THEN the insurance kicks in, like most insurance plans have.
They will also characterize treatments as major or minor and may pay out different percentages for each. I had crowns done which was major and my primary insurance at the time only covered 25%.
Also, both policies may be able to be in your name, but it can also be weird sometimes, since there may be a bit of a fight to determine who is the primary. (No one wants to be the primary, since they'd pay more.)
My wife's dental insurance is better through her work so I'm on that because my teeth hate me, but I also doubled up and kept mine through my own company, which is worse insurance. But because I'm the policy named-insured on my company's, that's the primary and the secondary cleans up whatever's left. 20% of 80% is the same as 80% of 20%, so it doesn't matter to me but it usually results in a weird flurry of inaccurate "THIS IS NOT A BILL BUT YOU MAY OWE" notices and then even bills that I ignore until they turn pink and only then do I call to figure out what's missing.
Insurance is confusing, inconsistent, difficult, poorly-documented, poorly-understood, variable, and a quagmire. The way that your dentist codes something can cause significant changes in what they're able to charge for a procedure, what they're able to get back from the insurance, and how both of your providers pay out, so don't be surprised if you just knock your own teeth out to save yourself the trouble.
posted by disillusioned at 4:32 PM on July 12, 2013 [1 favorite]
I actually work on the insurance industry. As a matter of fact, I had this exact question earlier today from a HR director who wanted to know for open enrollment.
It is totally legal to have 2 insurances. What could be potentially hazardous would be to have 2 insurances and not tell them about each other. Trying to double dip is potentially insurance fraud.
Now, the best that you could do would be to have to pay nothing. However, under some structures of coordination, the second insurance might subtract the first payment from the amount they will pay, which could give no additional benefit for you.
It will all depend on what the secondary insurance coordination of benefits provision is.
If you are getting insurance through your own employer, then insurance as an employee will be primary and your coverage as a spouse would be the secondary. If you are getting individual insurance, then it will probably be secondary to any insurance do to employment, whether it is yours or your spouse's, but could cost a lot more than the benefit you will ever potentially get out of it.
I hope all this is of some help to you.
posted by slavlin at 6:40 PM on July 12, 2013
It is totally legal to have 2 insurances. What could be potentially hazardous would be to have 2 insurances and not tell them about each other. Trying to double dip is potentially insurance fraud.
Now, the best that you could do would be to have to pay nothing. However, under some structures of coordination, the second insurance might subtract the first payment from the amount they will pay, which could give no additional benefit for you.
It will all depend on what the secondary insurance coordination of benefits provision is.
If you are getting insurance through your own employer, then insurance as an employee will be primary and your coverage as a spouse would be the secondary. If you are getting individual insurance, then it will probably be secondary to any insurance do to employment, whether it is yours or your spouse's, but could cost a lot more than the benefit you will ever potentially get out of it.
I hope all this is of some help to you.
posted by slavlin at 6:40 PM on July 12, 2013
Individual dental policies that you can buy on the marketplace are 99.999999% (always!) not as good as group plans through employers. Percentages paid, waiting periods, exclusions, downgrading codes are not going to result in a higher pay-out for your treatment, or a payment from them at all.
Scenario: Crown = $1000, for example. Primary(employer) insurance pays 50%(of their fee schedule, say $700) An in network dentist accepts the $700 as full-fee, doesn't bill the difference in fees, minus $50 deductible, so a total of: 1000-300(write-off)-350(50%InsPymnt)+50(Deductible,patient pays) = $400 patient responsibility, Insurance has paid $300. So you go to second insurance, whoops! They aren't In-Network, so there is either no payment or their payment level for a crown is $560, but they coordinate their payment with primary, and because they WOULD have paid $280 minus deductible, so $230, but because Primary paid more that, they get to pay nothing. Or they don't pay on crowns until you've been registered for a year. Or the policy doesn't even allow for crown benefit at all.
The only times having two policies is beneficial, is if they are employer/group plans, so your premium costs are lower, your payment levels are higher. And you perhaps know that this year, because I'm going to the dentist for the first time in years, I have several broken teeth, and gum issues and I know I'm going to surpass one policy's annual maximum. When that happens, THEN, the second insurance behaves as primary and starts paying toward their annual maximum of benefits. Also a great scenario: If your spouse has a union plan that pays a straight percentage (usually about 75%) of treatment, regardless of procedure code. Then you are talking about getting paid above the primary insurance's amount. But again, only if you need a considerable amount of treatment, just a couple of fillings now and then is not going to recoup your premium costs. And use In-Network dentists, because you don't just get the higher percentages, you also get the benefit of reduced fees off the top.
posted by Jazz Hands at 6:13 AM on July 13, 2013
Scenario: Crown = $1000, for example. Primary(employer) insurance pays 50%(of their fee schedule, say $700) An in network dentist accepts the $700 as full-fee, doesn't bill the difference in fees, minus $50 deductible, so a total of: 1000-300(write-off)-350(50%InsPymnt)+50(Deductible,patient pays) = $400 patient responsibility, Insurance has paid $300. So you go to second insurance, whoops! They aren't In-Network, so there is either no payment or their payment level for a crown is $560, but they coordinate their payment with primary, and because they WOULD have paid $280 minus deductible, so $230, but because Primary paid more that, they get to pay nothing. Or they don't pay on crowns until you've been registered for a year. Or the policy doesn't even allow for crown benefit at all.
The only times having two policies is beneficial, is if they are employer/group plans, so your premium costs are lower, your payment levels are higher. And you perhaps know that this year, because I'm going to the dentist for the first time in years, I have several broken teeth, and gum issues and I know I'm going to surpass one policy's annual maximum. When that happens, THEN, the second insurance behaves as primary and starts paying toward their annual maximum of benefits. Also a great scenario: If your spouse has a union plan that pays a straight percentage (usually about 75%) of treatment, regardless of procedure code. Then you are talking about getting paid above the primary insurance's amount. But again, only if you need a considerable amount of treatment, just a couple of fillings now and then is not going to recoup your premium costs. And use In-Network dentists, because you don't just get the higher percentages, you also get the benefit of reduced fees off the top.
posted by Jazz Hands at 6:13 AM on July 13, 2013
« Older Teaching Old Executives New Tricks | Plastic bottle of mouthwash left for 3 weeks in... Newer »
This thread is closed to new comments.
posted by shortyJBot at 4:32 PM on July 12, 2013