This article is for dentists caring for our members
When a member is covered by more than one insurer, rules called “coordination of benefits” ensure the correct insurer pays the member’s claim. However, sometimes patients don’t let us know that they have another insurer, which can cause us to pay their claims incorrectly.
Please ask patients to let us know about any other insurer they have. This will save you time and paperwork caused by any recoveries necessary to collect money paid in error. We’ve created a fact sheet that you can print out from our website to help educate your patients.
The following tips may help you manage claims more efficiently when your patient is covered by more than one insurer:
|If your patient||Then|
|Is the subscriber on the plan||The subscriber’s plan is primary.|
|Has two plans||The plan that has been in effect longest is primary.|
|Is a dependent over age 19||The “birthday rule” applies. The parent whose birthday falls first in the calendar year is primary.|
|Is a dependent under the age of 19 who is covered under the Essential health Benefits for pediatric dental||Their medical plan is primary.|
Note: We cannot accept a pre-treatment estimate from the primary carrier. This must be a clearly identified EOB.
Keep in mind that you can submit for coordination of benefits only when the member has a liability. You may not bill for coordination of benefits to collect any “adjusted” fee amount your office may have incurred.
Our coordination of benefits area includes a link to the member fact sheet discussed above, as well as information about: