Stand alone dental + MAPD dental
- Thread starter axeman462
- Start date
- 6,481
Caveats, I am NOT an agent. I have no experience using an MAPD plan.
I have used two stand alone dental plans at the same time. My comments below are based on that experience, I don't know how dental coverage in an MAPD might be different.
The patient should be sure the dentist will file claims for them. The patient must report both plans to the dentist. My experience is with UHC, BCBSKS, and Delta Dental of KS. For those companies, the plan the patient has held the longest will be the primary plan, the other will be the secondary plan. The dentist submits to the primary carrier, the claim is processed and EOB and any payment due go to the dentist. The dentist then files with the secondary carrier and receives another EOB and any additional payment due. The dentist will then bill the patient for any amounts due.
If the dentist is not in network with either carrier, the patient will owe the full amount of the dentist's charge, less any payment received from the carriers. (and DO NOT make the mistake of thinking that two dental policies means you get 4 cleanings per year.) If the the dentist is in network with one carrier, the bill will be adjusted to the allowed amount for that carrier, carrier payments will be subtracted and the patient will pay the remaining balance. If the dentist is in network with both carriers, there will be some more complicated adjusting on the dentist's books and the patient may still owe a balance, or sometimes there may be a resulting credit balance for the patient.
Deductibles will also complicate the adjustments. Some carriers will have separate deductibles for Basic and Major services.
Your client should recognize that many stand alone dental plans have waiting periods for Basic and/or Major services. The stand alone plan may waive the waiting period for MAPD dental coverage, you would have to ask.
If I was going to have two dental plans, I would want to see that the dentist I wanted to use would be in network for one of them.
And, when you understand the features of one carriers dental coverage, DO NOT ASSUME those precise same characteristics will carry over to other carriers' plans.
I have used two stand alone dental plans at the same time. My comments below are based on that experience, I don't know how dental coverage in an MAPD might be different.
The patient should be sure the dentist will file claims for them. The patient must report both plans to the dentist. My experience is with UHC, BCBSKS, and Delta Dental of KS. For those companies, the plan the patient has held the longest will be the primary plan, the other will be the secondary plan. The dentist submits to the primary carrier, the claim is processed and EOB and any payment due go to the dentist. The dentist then files with the secondary carrier and receives another EOB and any additional payment due. The dentist will then bill the patient for any amounts due.
If the dentist is not in network with either carrier, the patient will owe the full amount of the dentist's charge, less any payment received from the carriers. (and DO NOT make the mistake of thinking that two dental policies means you get 4 cleanings per year.) If the the dentist is in network with one carrier, the bill will be adjusted to the allowed amount for that carrier, carrier payments will be subtracted and the patient will pay the remaining balance. If the dentist is in network with both carriers, there will be some more complicated adjusting on the dentist's books and the patient may still owe a balance, or sometimes there may be a resulting credit balance for the patient.
Deductibles will also complicate the adjustments. Some carriers will have separate deductibles for Basic and Major services.
Your client should recognize that many stand alone dental plans have waiting periods for Basic and/or Major services. The stand alone plan may waive the waiting period for MAPD dental coverage, you would have to ask.
If I was going to have two dental plans, I would want to see that the dentist I wanted to use would be in network for one of them.
And, when you understand the features of one carriers dental coverage, DO NOT ASSUME those precise same characteristics will carry over to other carriers' plans.
- 29,522
I just asked this question last week.
- 29,522
Caveats, I am NOT an agent. I have no experience using an MAPD plan.
Better make sure both stand alone plans coordinate benefits. Manhattan and Aetna(CLI) don't
What was the answer?
- 29,522
What Midlevel said. File with your stand alone plan first, then file with Aetna, as they reimburse.
- 29,522
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