I have to have a few cavities filled and in addition, I need at least 2 crowns. I know I have a max per calender year, but what I'm wondering is if both plans have a deductible, and both pay 50% towards a crown, once I meet both plan deductibles...will the cost of the crowns cancel each other out...meaning both plan's will pay their respective 50%? I know I must find a provider that is in network for both plans as well...can anyone provide some advice?
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You can use one in conjunction with the other. If your wife's is a better plan then whatever your plan doesn't pay her's will pickup to their max. If yours pays 50% and hers pays 50% her's will not pay anymore on the crown. Where it will come in handy is once you reach your max for the year hers should continue to cover up to their max. Here's an example: You need two crowns. Say they cost $1,200.00 each. Your max is $1,100.00. Your's pays $600.00 for the first and $500.00 for the second (you've reached the yearly max). Her's will pay $100.00 for the second crown. If you need a cleaning or cavity later in the year her's will pay for that up to that max. This is how it worked for me. I have Aetna and Metlife as secondary. You might want to check with the provider or have the dentist do a pre-determination before starting work to be sure.
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