Dental Insurance benefits question…

[clh2]

Hello insurance experts…

My situation is…I need about $4k in dental work done, we are on my company’s dental plan, my dental insurance will pay approximately 1/2.

My husband, due to his employer being sold, is in an open enrollment period for insurance. We have 29 days to make any selections. If we opt for dental insurance with his new company’s plan-how does the coordination of benefits work? Is it possible that his company‘s dental would or could pick up part of the remaining $2000?

Any thoughts/concerns/ questions we should be asking would be appreciated!

 

[ronandannette]

Hello insurance experts…

My situation is…I need about $4k in dental work done, we are on my company’s dental plan, my dental insurance will pay approximately 1/2.

My husband, due to his employer being sold, is in an open enrollment period for insurance. We have 29 days to make any selections. If we opt for dental insurance with his new company’s plan-how does the coordination of benefits work? Is it possible that his company‘s dental would or could pick up part of the remaining $2000?

Any thoughts/concerns/ questions we should be asking would be appreciated!

Well, this is how most plans work if you are named as being covered. Your own policy will be "primary" and will be expected to pay it's full share. Your coverage under his policy will be your "secondary" and will only pay their portion of whatever is left. Unless of course, the specific policy has different terms. Your DH really needs to talk to his HR department or call the insurance carrier directly to find out the exact details.

Not that you asked, but if you have kids covered under both plans it's probably a little different. The parent with the earliest calendar-dated birthdate becomes their "primary" coverage and the other parent's plan is the secondary. That can be a real pain if one plan is substantially better than the other and you'd prefer it as the primary.

We have two coverages (each our own primary through our jobs and each are secondary on the spouse's plan). It's been very beneficial for drug coverage and dental.

 

[mumto3girls]

Ask if there is a waiting period before the benefits kick in. I just looked at dental at the end of last year and several plans had waiting periods before coverage would start although some covered routine things like cleanings from the start but more major services had a waiting period.

 

[mom2rtk]

Wouldn’t you just have one plan or the other and not both?

 

[tvguy]

Wouldn’t you just have one plan or the other and not both?

No. I have had double Dental Coverage since 1989. My plan pays first as it is primary, my wife's picks up the remaining balance as it is secondary. Haven't had a bill from a Dentist in those 33 years for anything other than braces for the kids*. That will change when my COBRA coverage expires in 5 months. I retired in July of 2021. I switched jobs in 1989 and my new employer paid 100% of all premiums for my entire family, so we kept my wife's coverage that we paid for and added mine at no extra cost. Just never dropped it even when they started charging.

*Orthodontic coverage is rare, or at least good coverage. I had an option to get orthodontic coverage. It required that you be in the plan two years or they would expect to you pay back all benefits. The MAXIMUM benefits it would pay was $2,000. The premium I would have had to pay over two years was.......$2,000. Thanks for nothing. Company didn't have anyone sign up, shockingly.

 

[_19disnA]

He needs to talk to HR as someone else mentioned. Every company/plan is different so no one on here can answer what his plan might cover. Generally, you can't claim the same expense on multiple plans. If you both work for different companies, doesn't it ask you to specify who else needs to be covered (such as a spouse?). I am also not clear why you would each have separate plans.

 

[barkley]

He needs to talk to HR as someone else mentioned. Every company/plan is different so no one on here can answer what his plan might cover. Generally, you can't claim the same expense on multiple plans. If you both work for different companies, doesn't it ask you to specify who else needs to be covered (such as a spouse?). I am also not clear why you would each have separate plans.

coverage selections can be determined by upfront cost as well as long term savings so over the years we've done it multiple ways-

individual coverage (each under own employer)

both with family coverage (under each employer)

currently-both with retiree coverage under my former employer PLUS we both have individual coverage under the medicare plans we selected.

in all the cases where one of us had dual coverage the insurance companies were both billed, whomever's primary was billed first and then the remainder was billed to their secondary.

the dental insurance under my medicare plan is absolutely lousy BUT their contracted negotiated rates are much lower than what the company my retiree benefits has negotiated so since the rule is that medicare based plans immediately become a person's primary insurance our dentist has to bill under that negotiated amount, they pay their pittance and then they submit the bill again to my retiree plan which ends up paying a larger percentage of the bill b/c they are being billed at a dramatically lower cost of service.

 

[tvguy]

Generally, you can't claim the same expense on multiple plans.

State laws vary on that. In California the law says insurance companies can't deny a claim based on there being another primary insurance.
Both my dental coverages are 50% of contracted rate. So my primary insurance has to pay 50% of the contracted amount, and the secondary 50% of the original contracted rate. Now, if the remaining balance is less than 50% of the original bill, then the secondary insurance only has to pay that.

 

[LoveSpringsteen]

How @ronandannette explained it above is usually how dual coverage works. My husband and I have each been on each other’s plans for years and we both cover the kids. For our family, it has been beneficial to have us all covered on both plans. Both plans paid for braces for my one child (my husband’s plan at the time didn’t include orthodontia for our other child), or when we’ve had other major work done.

It’s good advice, as others have said, to ask your husband to verify with his employer, when coverage starts.

 

[Imzadi]

Ask if there is a waiting period before the benefits kick in. I just looked at dental at the end of last year and several plans had waiting periods before coverage would start although some covered routine things like cleanings from the start but more major services had a waiting period.

THIS.

I'm having to pay nearly $4K out of pocket for a root canal and post & new crown. Due to all the downtime during the worst of the pandemic, I had to switch to a cheaper plan with the same insurance company. What I didn't realize was it is such a crappy plan that my primary care doctor and my dentist, both whom I love, do not accept that plan. Reading various online reviews of doctors and dentists who do accept that plan, they were worse stories than any Stephen King horror novel. So, while I had insurance coverage, there was no one that I wanted to be in their "care."

I was going to switched to a different & better insurance company that my Dr. accepted. However, that plan's dental only covered a root canal, post & crown after being on the plan for 3 years. Only generic check ups and cleanings, X-rays and a few other procedures added per year until year 3.

I finally chose a third company which my Dr. accepts that had open enrollment for a few more days. Better dental plan. However, this plan only covers a post & crown when the root canal was already done by one of their dentists covered by the plan. By this time, I had the root canal already done by my regular dentist, as I was in so much pain.) I decided to choose this insurance anyway as I get more (needed) medical coverage with my doctor and other future dental benefits.

I am having to pay out of pocket for ALL the $4K dental as I realized I really want to stay with my dentist's office to do the whole procedure. (They had done a root canal & crown about 20 years ago, and I've had no problems with it. I'm hoping for the same with this new one. ) They have worked with me and created a payment plan, so I can pay them directly and out of pocket s.l.o.w.l.y. and with no tacked on interest fees, like I would if I had to put it on a credit card.

Anyway, I found out all the info about what the different insurance companies' plans, benefits and doctors/dentist who accept those specific plans are via the different insurance websites. Nowadays, that info is all online and have the benefits & dentists laid out for each plan. It was all open access. I did NOT have to be a member first and input some membership number to get the booklet or coverage info or doctors participating for the plans I would have.

Just do a Google search for: insurance company + specific dental plan. It will hopefully bring up the info.

As a follow up, to make sure the info is up to date. Call your dentist to make sure they do accept that plan. And call the insurance company and speak to a rep to make sure you are truly covered for the procedures you need. I would not have found out the stipulation I needed the root canal done by them first, then get the crown - which IS covered, if I hadn't called. I would have seen the website saying they cover crowns, and have thought it was covered.

(Same for you, if you already had some work done. What will this new company cover of any on-going and new procedures? Also, one company said it would still cover me for a number of weeks if I was in the middle of some procedures. I think that is the law here in NYS, that even if my coverage is terminated, I can finish out certain procedures (for a certain number of weeks) before being forced to a different insurance company.

The rep did say, I could have the crown done by one of their dentists and then put in an appeal, asking that the crown be covered as the root canal had been done before I became a member. But, that was too iffy. I could still have been denied (after having it done,) and it wouldn't have been done by my usual dentist. That's when I decided I'd rather pay out of pocket.

 

[clh2]

I “get” the suggestion that my husband should ask the HR department, but as of day 1 being yesterday, they do not have a benefits person to direct questions to.


The advantage of having double coverage the rest of the year is, I have an appointment for early September, where my out of pocket will be $2k. If having a secondary insurance picks some of that up, it may be worth being dual-insured, until the end of the year.

it is just my DH and me on the insurance plan. DD left the nest years ago, so no worries concerns about coordinating benefits with a child, or orthodontia.

thanks to all who have responded, gives me ideas on how to word the questions.

 

[LuvOrlando]

Ask the dentists office staff, those clerical people know the ropes inside and out.

Also, think about the max Ins will contribute in a year, which is usually 1500. I deal with this by splitting expensive work into 2 years, maybe 3 getting the most out of the benefits. We liked to use flex spending to cover our portion, which you can access on day 1 of the year. We don't have flex now and instead have a HSA and need to wait for payroll to deposit in per month, which we do but is super tedious IMO

So endodontist & temp in one year and permanent crown the next year.

Implant surgery and temp in one year and permanent crown the next, or implant surgery summer, implant put in 6 months later the next year, temp when healed & permanent one the following year stretched out 3 years. Of course, they want things all at once so they don't lose out of work & money and will say don't, but really, you can drag your feet if you time it right.

An orthodontist can even work with you where top set of braces gets put on in December and bottom set in January so you can have 2 years of flex spending and 2 years of insurance.

 

[barkley]

I “get” the suggestion that my husband should ask the HR department, but as of day 1 being yesterday, they do not have a benefits person to direct questions to.


The advantage of having double coverage the rest of the year is, I have an appointment for early September, where my out of pocket will be $2k. If having a secondary insurance picks some of that up, it may be worth being dual-insured, until the end of the year.

it is just my DH and me on the insurance plan. DD left the nest years ago, so no worries concerns about coordinating benefits with a child, or orthodontia.

thanks to all who have responded, gives me ideas on how to word the questions.

i'm guessing the new coverage will be effective a certain set date to take over when the old coverage ends from former ownership (maybe september or october 1st). that said-find out the effective date, call your dentist and ask if they are contracted with the new provider. if they ARE they can answer the dual coverage question and figure out how to time out procedures to financially benefit you (ours does this for us using benefit coverage years/deductibles...). thing is-if your own insurance is sufficient for your normal non emergent dental work and you find that the cost of you being added to your dh's isn't worth the extra money on an ongoing basis you could always drop the coverage on just yourself during the next open enrollment. i suspect you could see another one this fall b/c most insurance companies do them in the fall for an effective date of january 1 of the following year. my adult child did an open enrollment into the plan the employer was offering the september of hire only to have to turn around in october and do another set of paperwork b/c the traditional open enrollment had rolled around.

 

[starry_solo]

The only thing you can get from your husband's HR company is details about the insurance plan. See if you can find out which insurance plan they will have and get a copy of the benefits/coverage, which you will then need to read and/or call the incoming insurance company's employees to get more information from.

 

[_19disnA]

Due to the company being sold and a new open enrollment period, likely EVERYONE who works there will be have various questions they need to get answered. Even if the HR person can't answer them on day 1, someone will quickly have to get up to speed and there could also be some 800# employees will be able to call. It isn't like your husband is the only person having questions about the coverages.