Problem with dental insurance plan

by Guest » Tue Nov 05, 2013 05:13 am
Guest

I’ve two dental insurance policies. The primary one is Delta PPO and the secondary is Delta Premier. The dentist I consult accepts both. In the policies, there is written that if the dentist accepts the insurance, it’s the dentist’s office that will file the claim for me. So suppose I receive a $1500 service, the primary insurance covers 20% and the secondary covers the remaining 80% and there is no deductible. So in that case I’m supposed to pay nothing, right? But I was asked to pay $1000 immediately upon receiving the service as they are worried about not getting paid by the secondary one. Again, they said that they’ll refund me if the secondary one repays them. It sounded ridiculous to me and so I’m posting it here in order to get a quick advice.

Total Comments: 6

Posted: Wed Nov 06, 2013 05:30 am Post Subject:

The only things that matters here is the Delta contract. Have you read that carefully or tried giving them a call? Talk to a Delta CSR and take a detail note of the conversation. You could even record the call since the amount involved is huge! If possible request them for a written document confirming any amount you need to pay and the conditions that you need to abide by.

Posted: Wed Nov 06, 2013 06:41 am Post Subject:

If the refund mechanism takes place, things will become more complicated. The amount you are thinking of getting back would actually be put on hold and you’ll get that only after the secondary claim is processed. Even if they refund, they’ll send it to FSA first, and eventually you’ll end up paying taxes on that.

What is most weird is that if they are sure that they’d get paid from the primary one and ask you to copay only, why the hell do they not trust the secondary insurance, especially when both come from the same firm?

Posted: Wed Nov 06, 2013 04:17 pm Post Subject:

Read your contracts carefully as only one will probably pay benefits. Most insurance companies will not construe a coordination of benefits provision between two plans unless both are group policies and come from separate employers.

When you have individual insurance, if you want two plans to cover 100% of your expenses (or close to it), the two plans usually must come from separate insurance companies.

It's the same sort of thing a having one auto insurance policy covering the two vehicles you own. You cannot run into one of the vehicles with the other and expect the policy to pay 1005 of the damages done to one, and 100% of the damages after the deductible on the other, as if two different insurance companies were involved.

Posted: Sun Dec 29, 2013 01:38 am Post Subject: Sounds like they want their money up front and out of pocket

Sounds like they want the insurance to pay the 20% and you to pay the 80%...because when a patient pays that's money in their pocket right then and there at the time of the service..no claim forms for you or the dentist to file, in other words no paper work and no waiting. Have you thought about using a discount dental service? You would pay at the time of service but not 1K! The discounts are 60-80% off and you can use them immediately no waiting 6-12 months. No premiums, no deductible or limits on services either.

Posted: Tue Dec 31, 2013 05:16 am Post Subject:

No premiums

Don't lie! Your "discount" dental "plan" costs $239.40 per year.

No matter what you want to call your "it's not insurance" plan, it's not free.

Even though you are not a licensed insurance agent, who must observe the insurance laws of Texas, you cannot make such stupid misrepresentations as this. There is still the Deceptive Trade Practices Act that you must abide by.

Posted: Tue Dec 31, 2013 07:33 pm Post Subject:

it's not a premium because it's not insurance..it's a membership fee..with a 30 day money back guarantee...the cost was never mentioned...but you're right it's not free..either way it's not insurance and therefore no premium.

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