One plan will pay 80% of it's coverage the other
will pay 20% of it's coverage and we still owe
25 to 30% go figure.
2006-10-27 11:46:37 · 7 answers · asked by JaY Stan 1 in Health ➔ Dental
Well, you must get into a sort of Voodoo Math invented by insurance companies to get out of paying.
Here's how it works: your primary plan pays first - in your case 80%. After the primary pays, the secondary is billed. What they pay depends on a clause called "coordination of benefits".
"Full" or "standard" coordination means - if your bill is $100 and the first insurance paid $80, the second insurance would pay $20 and you wouldn't have to pay anything.
"Non-duplication" means - if your bill is $100 and the first insurance paid $80, the secondary would subtract that $80 from what they would have paid if they were primary. So, if their "usual and customary" payment would have been $80, then there is nothing left for them to pay. If, however, the primary only paid $60, they would pay the balance of what they WOULD HAVE PAID, which would be $20.
Confusing? I've only described the two most common types of coordination of benefits - there are many more.
It's great that you have two plans, and in some cases it will help you a lot. Sometimes, it doesn't pay to carry the secondary because you end up paying more in premiums than you will ever get in benefits.
Insurance companies are in business to make money for shareholders. To do that, they must take in more in premiums than they pay out. They will make it as difficult as possible to pay claims - that's their job.
2006-10-27 13:16:09 · answer #1 · answered by emmalue 5 · 1⤊ 0⤋
Just a suggestion but try asking your dentist to accept your insurance plans payment as paid in full. And ask for a discount if you pay timely, in full or by cash. And as always ask your dentist for the treatment plan including the costs to submit to your insurance company for review. And also before buying your dental insurance plan know the customary dental charges of your area. And if helpful visit these sites for 15 tips to cut dental costs. Hope you find this helpful.
2006-10-27 12:44:17 · answer #2 · answered by dentalplancenter 2 · 0⤊ 0⤋
I know! my dental plan sucks! It has $1000 per year cap on it, so 1 root canal (of which I still had to pay 20%), and now I'm done for the year!
2006-10-27 11:48:53 · answer #3 · answered by S J 2 · 0⤊ 0⤋
First they usually bill your primary insurance.
Also there is what is called usual and customary fees( I think thats what they are called)....but your dr. can charge anything he wants...but insurance may not pay that high of a rate...and you are required to make up the difference...plus your 20%
2006-10-27 11:59:16 · answer #4 · answered by kissmybum 4 · 0⤊ 0⤋
Emmalue has accurately described what some call the "least benefits coverage" clause. This is illegal in New Jersey, so it might also be illegal in your state.
2006-10-27 16:17:40 · answer #5 · answered by Picture Taker 7 · 0⤊ 0⤋
Insurance companies are businesses that exist to make money. Once you realize this, you'll understand why it is they take oodles of money from you and bicker over every last payment.
2006-10-27 11:53:46 · answer #6 · answered by Anonymous · 0⤊ 0⤋
Check your deductibles. You may have a high deductible or a per procedure deductible.
2006-10-27 11:50:44 · answer #7 · answered by BD in NM 6 · 0⤊ 0⤋