Thursday, January 20, 2011

How does dental insurance work?

I have 2 dental insurance policies. Blue Cross/Blue Shield & Met Life. Will they work together and pay 100% like one pays 80% the other paying the remaining 20%, or will only one pay? Will I have any out of pocket expenses? Will I have to pay a co pay or deductable? I've tried to read over my policies but they might as well have been written in french.
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I have worked with dental ins for a long time. When you're trying to figure out what ins will pay it is really a math problem. First you need to determine what you're benefits are. There are 3 main categories: Preventative, Basic, and Major procedures. Most policies cover these categories as followed. Preventative (cleanings and such) 100% Basic (fillings, perio disease, extractions, root canals) 80% Major (Crowns, Dentures) 50% To determine what each ins company will pay, you need to know what the procedure will cost, if both policies cover the procedure, and how much is covered. Lets say that BCBS is your primary policy and metlife is your secondary. Lets also say that they both have the same policy coverage (100%, 80%, and 50%). If you are having a preventative procedure done, then BCBS should pay for all of it and Metlife is off the hook. Lets say you are getting a filling done that costs $100 total for the procedure. BCBS would pay $80 of the filling because they cover it at 80%. The remaining $20 is requested from Metlife and they should cover 80% of that, which is $16 dolars. The remaining $4 is your portion. The same goes for Major. If a major procedure costs $1000, BCBS will pay $500 and Metlife will pay $250. Something to consider when figureing out what ins will pay and what your portion is, is that you pay have a maximum and a deductible in your plan. That gets trickier to figure out. I hope this helps, if it does, vote this for best answer please. I'm trying to rack up my points!
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