There’s a special kind of optimism that walks into a dental office.

It sounds like this:

“Don’t worry. I have secondary insurance.”

Cue the angels singing.
Cue the front desk sigh of relief.
Cue the billing department quietly whispering, “Lord, give me strength.”

Because if you’ve been in dentistry longer than 15 minutes, you know the truth:

Secondary insurance is not always the hero.
Sometimes… it’s the plot twist.

Coordination of Benefits: The Promise vs. The Reality

On paper, Coordination of Benefits (COB) sounds wonderful.

Two insurance plans.
One patient.
Less out-of-pocket cost.

In theory? Beautiful.
In practice? It’s like assembling IKEA furniture with missing screws and instructions written in legal Latin.

And then comes the clause that makes seasoned administrators twitch:

The “Non-Duplication of Benefits” Clause.
If you know, you know.

The Non-Duplication “Gotcha”

Here’s how most patients think it works:

Primary pays what they pay.

Secondary swoops in and covers the rest.

Everyone goes home happy.

Here’s how it actually works with non-duplication:

The secondary carrier calculates what they would have paid as primary.

If their allowed amount is higher than what primary paid? They may pay the difference.

If their allowed amount is the same or lower?

• They pay zero.

Zero.
Zilch.
Nada.

And now guess who gets to explain that to the patient?

Not the insurance company.

You.

The Surprise Bill Nobody Wants

If your team doesn’t spot non-duplication during verification, here’s what happens:

• You estimate based on “two insurances.”

• The patient pays less up front.

• Secondary denies or pays nothing.

• Now there’s a balance.

• The patient says, “But I have TWO insurances!”

And suddenly your treatment coordinator is in a hostage negotiation over $312.47.

Your options:

• Bill the patient and risk trust erosion.

• Write it off and quietly absorb the hit.

• Spend hours on appeals that go nowhere.

Multiply that by 5 to 10 patients a month and congratulations, you’ve just created a silent revenue leak.

Why This Isn’t Just a Billing Problem

Benjamin, you’ve built your entire career around protecting the financial integrity of quality care. And this is exactly where practices lose control, not in the operatory, but in the fine print.

COB mistakes are leadership issues disguised as administrative hiccups.

Because this isn’t about paperwork.

It’s about:

• Accurate verification protocols

• Clear financial conversations

• Team confidence

• Protecting production

If your team treats secondary insurance like a bonus lottery ticket instead of a contractual chess match, you’re gambling with your margins.

The Real Fix: Training and Systems

Here’s the uncomfortable truth:

Most teams verify that there is secondary insurance.

Very few verify how it coordinates.

There’s a big difference between:

“Yes, they have dual coverage.”

And:

“This secondary plan follows non-duplication rules, so we need to estimate conservatively and inform the patient up front.”

That second sentence?
That’s what protects your practice.

When your team knows to ask:

• Does the secondary follow non-duplication?

• What is their allowed amount?

• How do they calculate COB?

• Do they use maintenance of benefits language?

Now you’re not reacting.

You’re leading.

Stop Playing Insurance Roulette

Insurance companies are not confused about their policies.

They understand their clauses very well.

The only question is whether your team does.

Because when your staff isn’t trained in COB nuances:

• You under-collect.

• You overestimate.

• You refund later.

• You write off balances.

• You erode trust.

And all of that feels like “just part of dentistry.”

It’s not.

It’s preventable.

Here’s the Bigger Question

Is your team:

• Verifying secondary like a checklist item?

• Or analyzing it like a contract?

Because secondary insurance isn’t extra coverage.

It’s extra complexity.

And complexity without training equals leakage.

The Bottom Line

Secondary insurance can absolutely benefit patients.

But only when you understand the rules of the game.

Otherwise, it becomes:

• More phone calls

• More rework

• More write-offs

• More awkward conversations

• And less profit for the practice doing all the actual work

The practices that win?

They don’t complain about insurance games.

They train for them.

So let me ask you:

Is your team prepared to handle non-duplication clauses with confidence…

Or are you still hoping the secondary plan will “save the day”?

Because hope is not a financial strategy.

Training is.

Benjamin Tuinei
Founder – Veritas Dental Resources, LLC
📞 888-808-4513
Services: PPO Fee Negotiators, PPO Fee Negotiating, Insurance Fee Negotiating, Insurance Credentialing, Insurance Verifications
Websites: www.VeritasDentalResources.com, www.VerusDental.com