[OT] confused and worried about dental insurance

I guess I have the problem most people only wish they had. I'm
covered by two dental insurance plans. But I'm not sure it's a good
thing.

See, I've been using my husband's insurance, which has pretty good
coverage both in and out of network. My new company provides dental
insurance for free. That should be good, right?

Well, my new company's dental insurance is great for in-network stuff,
but not so much out of network. And naturally the dentist I adore,
and the endodontist he recommends (well, actually, as near as I can
tell, all the endodontists in Boulder) are out of network.

As near as I can figure by googling, your primary insurance company
*must* be your employer's. That means they get the bill first. Then
your secondary insurance gets the remainder, but as near as I can tell
they can decide how they want to deal with that. For example, if the
first company covers 40% and the second company covers 80%, the second
company gets a choice of whether to cover the remaining 40% or whether
they want to cover 80% of 60% (see why I'm confused?) Of course both
have deductables and whatnot, and both have yearly maximums.

To make this even more fun, DH is on vacation and so can't contact his
HR person; my HR person is on vacation this week. I have an appt next
Tuesday for attempt number 2 of a root canal. See, the endodontist
couldn't find the canal last time he tried. But now the tooth has
really started to hurt, so we're going to try to find the canal again.
A successful root canal would be the glowingly happy and wonderful
option. If that doesn't work, most likely because he accidentally
pokes a hole in my tooth, I will need to get the tooth extracted and
(I guess this isn't strictly speaking required, but it is as far as
I'm concerned) an implant to replace it. The endo doc tells me an
implant, including crown, is about $3000. Youch. But it's best to do
the implant at the time of the extraction, because the hole's already
there. I think the root canal is about $800; the attempt last week he
only charged $100 for. But no idea what my insurance company will
make of that. Oh, yes, and I don't have my new insurance company
listed for them, because I didn't realize I had to. So I really hope
this doesn't screw me out of benefits somehow.


--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

*deep breath*

Finally found DH's insurance info. I think I'll be okay.

Both cover 100% of routine care, no matter whether you go in-network
or not. 100% of reasonable and customary, of course.

Both have the same deductable.

Both cover 50% or 60% for "class C" services, which include crowns and
(I think) implants, if implants are "partial, full or removable
dentures."

My new dental actually covers 100%/80% of "class B" (including root
canals and extractions), whereas DH's covers 90%/80%. So
percentage-wise the new stuff is better. But DH's annual max is
$1500, vs. the $1000 for the new stuff.

All of this stuff will be out of network ... so actually it's 80%
regardless ... but the effective annual max of $2500 instead of $1000
will be very nice this year ...

Sorry if I appear to be freaking out. My jaw hurts, DH is on a trip
and hasn't answered his phone or arrived at the midway point yet (and
should have, hours ago), and I'm really confused.

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

"Monique Y. Mudama" wrote in message
...
*deep breath*

Finally found DH's insurance info. I think I'll be okay.

Both cover 100% of routine care, no matter whether you go in-network
or not. 100% of reasonable and customary, of course.

Both have the same deductable.

Both cover 50% or 60% for "class C" services, which include crowns and
(I think) implants, if implants are "partial, full or removable
dentures."

My new dental actually covers 100%/80% of "class B" (including root
canals and extractions), whereas DH's covers 90%/80%. So
percentage-wise the new stuff is better. But DH's annual max is
$1500, vs. the $1000 for the new stuff.

All of this stuff will be out of network ... so actually it's 80%
regardless ... but the effective annual max of $2500 instead of $1000
will be very nice this year ...

Sorry if I appear to be freaking out. My jaw hurts, DH is on a trip
and hasn't answered his phone or arrived at the midway point yet (and
should have, hours ago), and I'm really confused.

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

I don't blame you. It's hard to figure anything out when you're in pain,
and I think insurance companies try to keep us as confused as possible.

Joy

On Tue, 5 Jul 2005 22:06:52 -0600, "Monique Y. Mudama"
wrote:

I guess I have the problem most people only wish they had. I'm
covered by two dental insurance plans. But I'm not sure it's a good
thing.

See, I've been using my husband's insurance, which has pretty good
coverage both in and out of network. My new company provides dental
insurance for free. That should be good, right?

Well, my new company's dental insurance is great for in-network stuff,
but not so much out of network. And naturally the dentist I adore,
and the endodontist he recommends (well, actually, as near as I can
tell, all the endodontists in Boulder) are out of network.

As near as I can figure by googling, your primary insurance company
*must* be your employer's. That means they get the bill first. Then
your secondary insurance gets the remainder, but as near as I can tell
they can decide how they want to deal with that. For example, if the
first company covers 40% and the second company covers 80%, the second
company gets a choice of whether to cover the remaining 40% or whether
they want to cover 80% of 60% (see why I'm confused?) Of course both
have deductables and whatnot, and both have yearly maximums.

To make this even more fun, DH is on vacation and so can't contact his
HR person; my HR person is on vacation this week. I have an appt next
Tuesday for attempt number 2 of a root canal. See, the endodontist
couldn't find the canal last time he tried. But now the tooth has
really started to hurt, so we're going to try to find the canal again.
A successful root canal would be the glowingly happy and wonderful
option. If that doesn't work, most likely because he accidentally
pokes a hole in my tooth, I will need to get the tooth extracted and
(I guess this isn't strictly speaking required, but it is as far as
I'm concerned) an implant to replace it. The endo doc tells me an
implant, including crown, is about $3000. Youch. But it's best to do
the implant at the time of the extraction, because the hole's already
there. I think the root canal is about $800; the attempt last week he
only charged $100 for. But no idea what my insurance company will
make of that. Oh, yes, and I don't have my new insurance company
listed for them, because I didn't realize I had to. So I really hope
this doesn't screw me out of benefits somehow.

Wow, Monique, what a maze! I hope this works out for you somehow.
Personally, I think insurance companies are EVIL. Heh. But I hope
having two of them makes this come together for you, and that you get
the work done you need.

Ginger-lyn

Home Pages:
http://www.spiritrealm.com/summer/
http://www.angelfire.com/folk/glsummer (homepage & cats)
http://freepages.genealogy.rootsweb....mmer/index.htm (genealogy)
http://www.movieanimals.bravehost.com/ (The Violence Against
Animals in Movies Website)

Don't have any advice to give you, but we will purr and pray that everything
works out your way.
Lily & her mama
Jazz, RB

--

Irulan
from the stars we come
to the stars we return
from now until the end of time
"Monique Y. Mudama" wrote in message
...
I guess I have the problem most people only wish they had. I'm
covered by two dental insurance plans. But I'm not sure it's a good
thing.

See, I've been using my husband's insurance, which has pretty good
coverage both in and out of network. My new company provides dental
insurance for free. That should be good, right?

Well, my new company's dental insurance is great for in-network stuff,
but not so much out of network. And naturally the dentist I adore,
and the endodontist he recommends (well, actually, as near as I can
tell, all the endodontists in Boulder) are out of network.

As near as I can figure by googling, your primary insurance company
*must* be your employer's. That means they get the bill first. Then
your secondary insurance gets the remainder, but as near as I can tell
they can decide how they want to deal with that. For example, if the
first company covers 40% and the second company covers 80%, the second
company gets a choice of whether to cover the remaining 40% or whether
they want to cover 80% of 60% (see why I'm confused?) Of course both
have deductables and whatnot, and both have yearly maximums.

To make this even more fun, DH is on vacation and so can't contact his
HR person; my HR person is on vacation this week. I have an appt next
Tuesday for attempt number 2 of a root canal. See, the endodontist
couldn't find the canal last time he tried. But now the tooth has
really started to hurt, so we're going to try to find the canal again.
A successful root canal would be the glowingly happy and wonderful
option. If that doesn't work, most likely because he accidentally
pokes a hole in my tooth, I will need to get the tooth extracted and
(I guess this isn't strictly speaking required, but it is as far as
I'm concerned) an implant to replace it. The endo doc tells me an
implant, including crown, is about $3000. Youch. But it's best to do
the implant at the time of the extraction, because the hole's already
there. I think the root canal is about $800; the attempt last week he
only charged $100 for. But no idea what my insurance company will
make of that. Oh, yes, and I don't have my new insurance company
listed for them, because I didn't realize I had to. So I really hope
this doesn't screw me out of benefits somehow.


--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

On 2005-07-06, penned:
Wow, Monique, what a maze! I hope this works out for you somehow.
Personally, I think insurance companies are EVIL. Heh. But I hope
having two of them makes this come together for you, and that you
get the work done you need.

Ginger-lyn

I think it will work out. Let me put it this way: I am not going to
live with pain if there's a way to fix it, so I'm getting the work
done. I believe the insurance companies will cover it. If they
don't, my credit cards may groan, but at least my face won't hurt.

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

On 2005-07-06, Irulan penned:
Don't have any advice to give you, but we will purr and pray that
everything works out your way. Lily & her mama Jazz, RB

Thank you =)

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

Monique Y. Mudama wrote:
I guess I have the problem most people only wish they had. I'm
covered by two dental insurance plans. But I'm not sure it's a good
thing.

See, I've been using my husband's insurance, which has pretty good
coverage both in and out of network. My new company provides dental
insurance for free. That should be good, right?

Well, my new company's dental insurance is great for in-network stuff,
but not so much out of network. And naturally the dentist I adore,
and the endodontist he recommends (well, actually, as near as I can
tell, all the endodontists in Boulder) are out of network.

As near as I can figure by googling, your primary insurance company
*must* be your employer's. That means they get the bill first. Then
your secondary insurance gets the remainder, but as near as I can tell
they can decide how they want to deal with that. For example, if the
first company covers 40% and the second company covers 80%, the second
company gets a choice of whether to cover the remaining 40% or whether
they want to cover 80% of 60% (see why I'm confused?) Of course both
have deductables and whatnot, and both have yearly maximums.

To make this even more fun, DH is on vacation and so can't contact his
HR person; my HR person is on vacation this week. I have an appt next
Tuesday for attempt number 2 of a root canal.

In general, your insurance is primary. Then, using a clause known in the
insurance industry as coordination of benefits, your husband's carrier is
responsible for any charges not covered by your primary (assuming the
deductible on his has been met). They don't get to pick and choose what
percentage they pay out. If yours pays 80% they will pay the remaining 20%.
Again, after the deductible.

Jill

On 2005-07-07, jmcquown penned:

In general, your insurance is primary. Then, using a clause known
in the insurance industry as coordination of benefits, your
husband's carrier is responsible for any charges not covered by your
primary (assuming the deductible on his has been met). They don't
get to pick and choose what percentage they pay out. If yours pays
80% they will pay the remaining 20%. Again, after the deductible.

Jill

Well, I found a link that says

"For groups with a non-duplication of benefits rule in their plan, the
secondary carrier pays only the difference between what the primary
carrier actually paid and what the secondary carrier would have paid
if it had been the primary carrier."

http://www.deltadentalins.com/enroll..._coverage.html

I don't see anything about non-dupe stuff in my paperwork, but I
don't know if it would be in the overview packages.

I suspect it won't matter, as the only reason this will become a real
issue is if I have a lot of work done, in which case I'll hit the max
payout for the first and the second will have to pay up, anyway.

--
monique, who spoils Oscar unmercifully

pictures: http://www.bounceswoosh.org/rpca

Monique Y. Mudama wrote:
On 2005-07-07, jmcquown penned:

In general, your insurance is primary. Then, using a clause known
in the insurance industry as coordination of benefits, your
husband's carrier is responsible for any charges not covered by your
primary (assuming the deductible on his has been met). They don't
get to pick and choose what percentage they pay out. If yours pays
80% they will pay the remaining 20%. Again, after the deductible.

Jill

Well, I found a link that says

"For groups with a non-duplication of benefits rule in their plan, the
secondary carrier pays only the difference between what the primary
carrier actually paid and what the secondary carrier would have paid
if it had been the primary carrier."

That's insurance speak for they won't double-pay the provider (or reimburse
you twice, if you paid out of pocket and then filed two claims in an attempt
to get double reimbursement). It essentially means what I said

I was a licensed insurance agent from 1984 until 1990, even though I never
actually *sold* insurance. I worked for The Prudential from 1982 - 1988 and
then for a third-party-claims administrator assisting brokers in selecting
health and dental plans for their clients until 1990. I decided I was more
interested in computers than insurance policies, but some of the information
sticks

http://www.deltadentalins.com/enroll..._coverage.html

I don't see anything about non-dupe stuff in my paperwork, but I
don't know if it would be in the overview packages.

I suspect it won't matter, as the only reason this will become a real
issue is if I have a lot of work done, in which case I'll hit the max
payout for the first and the second will have to pay up, anyway.

Yep, you should be fine

Jill