Understanding Coordination of Benefits: Resolving Health Care Bills with Multiple Insurers

If you find yourself with coverage from multiple health insurance plans, you may wonder if both can contribute to covering your medical expenses. In this blog post, we’ll delve into the concept of coordination of benefits (COB), examining how it works and the steps you can take to ensure both insurers pay their fair share.

What is Coordination of Benefits?
Coordination of benefits refers to the process of determining which health insurance plan is primarily responsible for paying your medical bills when you have multiple policies. In most cases, the plan you or your family member has had the longest is considered primary. However, there are exceptions to this rule, such as when employer-sponsored plans are involved.

Employer-Sponsored Plans: Primary Coverage
In general, employer-sponsored health insurance plans are considered primary, regardless of the length of time they have been in effect. This means that your employer plan will typically be responsible for paying the majority of your medical expenses, before any other insurance you may have.

Multiple Insurances: COB Process
When you have multiple health insurance policies, the COB process ensures that both insurers don’t end up paying the entire bill. Here are the steps involved in COB:

1. Identify the Primary Insurer: Determine which plan is the primary insurer, typically based on employer coverage or the policy you’ve had the longest.
2. Submit Claims to Primary Insurer: File your medical bills with the primary insurer first. The primary insurer will process the claim and determine its portion of the payment.
3. Secondary Insurer Submission: Once the primary insurer processes the claim and pays its share, submit the Explanation of Benefits (EOB) to your secondary insurer. The secondary insurer will review the EOB and determine if there is any remaining balance they are responsible for.
4. Coordination: The secondary insurer will coordinate with the primary insurer to determine the remaining amount owed. The secondary insurer may cover a portion of the remaining balance or apply it towards your deductible.

Benefits of COB
Understanding COB is crucial for maximizing your health insurance coverage. It helps to:

– Ensure both insurers contribute to your medical expenses
– Prevent overpaying for medical bills
– Avoid unnecessary collections efforts
– Optimize the benefits of your multiple health insurance policies

Seeking Professional Help
Coordinating multiple health insurance plans can be complex. If you have questions or need assistance, do not hesitate to reach out to a licensed insurance agent or health insurance professional. They can provide personalized guidance and assist you with submitting claims and resolving any discrepancies.