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I went to the dentist (Root Canal). I should say this is small time but it really bothers

me that I think I...
I went to the dentist (Root Canal). I should say this is small time but it really bothers me that I think I was ripped off.
I was double insured and my work Insurance was billed as the primary and my wife’s insurance which was much better because it is more expensive was the secondary according to the secretary at the dentist office. I did not ask for my cheapo insurance to be the primary. The primary had a lower rate and paid half and Delta used their rates to evaluate what they paid and stiffed me for $300 while they saved over $300 because of my other Insurance. I saved nothing.
If I had not had the other insurance Delta would have had to pay $1000 but instead paid 500 so if they had covered the bill it still would have saved them $200. Having my other insurance saved me nothing.
My other insurance is a cheapo but Delta isn’t so why can they use my cheapo insurance as a guide for what they pay?
I know this isn’t big money but getting ripped off is never pleasant.
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Answered in 13 minutes by:
6/26/2013
John Legal
John Legal, Attorney
Category: Legal
Satisfied Customers: 4,632
Experience: Over 15 years legal experience.
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Welcome! Thank you for your question.

You can raise your issue with the department of insurance in California. What you do need to know is that the way insurance companies evaluate who is primary and who is secondary is not based on choice but based on who's company is supplying the insurance. Since your company is supplying the cheapo policy, it is your primary. Your wife's insurance is automatically the secondary.

With that said you need to request to see your wife's insurance policy. Your wife's policy will have details on coordination of benefits. This is how insurance companies coordinate the payment under plans to be sure that a claim is not double paid. The details of her insurance company's coordination of benefits will control how your claim should be paid.

Here is an only pamphlet from Delta dental that states that their coordination of benefits would have paid up to the amount that they would otherwise cover in your scenario. http://www.deltadentalins.com/individuals/guidance/dual_coverage-8x11.pdf



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John Legal
John Legal, Attorney
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Customer reply replied 4 years ago

I guess then since my primary pays so much less than Delta I should cancel my primary. That would save me $300 and having that insurance saved me nothing.

Absolutely your primary makes no difference here. You are correct that you are much better under just your wife's policy. You may want to double check out your health insurance as well. The rules are the same for health insurance.

John
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