How does secondary insurance work? This is a common question among dental professionals trying to accurately submit multiple insurance plans per patient. A patient is covered by multiple insurance plans, and you’re unsure how to file it - and you just want to be accurate and compliant.
Dental ClaimSupport is a trusted dental billing partner that has helped dental teams submit secondary claims to insurance for quick reimbursement. Our billers are experts on subjects such as primary and secondary insurance. Through our years of helping dental teams get the claims income they’ve earned, we have seen how important it is to understand how secondary insurance works.
Your cash flow depends on it.
In this article, we will explain how secondary insurance works, and map out a few examples to help you further understand. Accepting multiple insurance plans from patients can increase your pool of patients, but if you are not properly submitting claims in the correct order, you’ll face delays in payment. Let’s get into it.
What is Coordination of Benefits (COB)?
To understand how secondary insurance works, you first need to understand the meaning of Coordination of Benefits.
COB is the order in which you file insurance claims for patients covered by multiple insurance plans. One of these plans will be primary, one will be secondary. And if there is a third (tertiary) and fourth (quaternary). But for the sake of simplicity, we’re going to focus on secondary. It’s also more common to be covered by 2 or fewer insurance plans.
COB is a set of rules that help you determine the order in which you file the claims. It is a list that you can refer to for each patient’s different situation.
COB is a topic that many dental professionals dread learning about. It can get complicated, as there are several rules and stipulations to follow. And memorizing insurance rules can be challenging!
How does secondary insurance work?
When you are handling a patient who is covered by multiple insurance plans, secondary insurance is the insurance plan that will be filed second. Seems simple enough, right? But the concept dental professionals struggle with is determining which insurance plan is secondary.
According to this Dual Coverage article from Dental Dental, (in most cases), secondary insurance will not accept a claim until after the primary insurance has paid for services according to the patient’s available benefits under that policy.
The article continues by explaining how the secondary insurance will then ask for a copy of the explanation of benefits from the primary insurer.
Secondary insurance is determined by several factors: dates of enrollment, birthdays, your insurance vs your spouse's insurance, and length of coverage. In your software, there is a space where you will label the claim as primary or secondary. Some software has a drop-down option, some have you label the order with a number.
This is an example in OpenDental practice management software. The “Order” is where you would determine whether the claim is primary (1) or secondary (2).
The good news is, the rules don’t typically get more technical than that! And when you read through the rules of COB, they logically make sense. When in doubt, you can always call the insurance companies to clarify which would be filed as primary and secondary.
What are some examples of secondary insurance?
When we say determining how secondary insurance works is logical, here is what we mean.
Example 1: Let’s say two spouses each have their respective insurance plans from their own jobs. They are also enrolled in each other’s plans as well. Their own insurance plan, through their own job, would be their primary insurance, while their spouse’s plan would be the secondary insurance. This is called the Spousal Coverage rule.
That’s pretty straightforward.
Here’s another:
Example 2: Let’s say a child is under both parents’ respective insurance plans. Which would be the child’s primary and secondary insurance? The primary insurance would be the parent whose birthday falls first in the year. This is called The Birthday Rule. If they have the same birthday, then the plan that was in place first would be primary. A divorce decree could trump the birthday rule.
Remember how we mentioned dates and length of coverage are huge factors in determining which is primary and which is secondary? These examples illustrate that idea.
There are more complicated examples that you can read about in 10 standard Coordination of Benefits rules for dental insurance billing.
Don’t let secondary insurance rules keep you from collecting from dental insurance
Figuring out how secondary insurance works can be a challenge, but learning COB rules is crucial for proper claim submission. And proper claim submission leads to faster reimbursement.
Take the time to learn more about COB rules so that your team can feel confident when they create and submit claims. And if you would rather someone else handle it for you, that’s an option too.
Dental ClaimSupport’s billers are continuously trained on topics such as Coordination of Benefits and can create a worry-free claims process for you so that you can focus on patients.
To learn more about how Dental ClaimSupport can make claims revenue possible, schedule a call with one of our experts.
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