Patient Guide: Coordination of Benefits

Coordination of Benefits (COB) is an essential process in healthcare billing. It helps ensure that if you have multiple insurance plans, the payments are coordinated correctly to avoid duplication of coverage and prevent overpayment. COB determines which insurance plan is primary (pays first) and which is secondary (pays second) if there are remaining expenses.

However, sometimes issues can arise with COB, leading to confusion or billing discrepancies. Below is a guide on how to understand COB and the steps you should take if you encounter any issues. Once the issue is resolved, please be sure to notify Siyan Clinical Corporation so they can update your records and proceed with accurate billing.

What is Coordination of Benefits?

Coordination of Benefits (COB) is the process by which insurance companies determine the order in which they pay for covered medical services when you have more than one health insurance plan. The primary insurance pays first, and if there are any remaining costs, the secondary insurance may cover additional expenses.

Primary insurance: This is the insurance plan that pays first.
Secondary insurance: This plan may pay for additional expenses that the primary insurance does not cover.
Patient responsibility: After both plans have paid, any remaining balance is typically your responsibility.

This process ensures that there’s no double payment, reduces out-of-pocket costs, and makes the billing process smoother for patients.

Why is Coordination of Benefits Important?

COB is essential when a patient has multiple insurance plans. Common examples where COB applies include:

Under 26 and on a parent’s plan: When a child is covered by both a parent’s insurance and their own employer’s insurance.
Marketplace and employer plans: If a patient has both a marketplace insurance plan and another employer-sponsored plan.
Two parents covering a child: When both parents have insurance and their child is covered by both policies.
Spouse coverage: If a person is covered by both their spouse’s plan and their own employer’s plan.
Medicare/Medicaid and private insurance: If someone has Medicare or Medicaid and also has private insurance.

COB helps avoid double payments and ensures that the right insurance covers the appropriate expenses.

Common COB Rules

COB rules can vary based on location, the type of insurance, and other factors. However, some general rules include:

Medicare and private insurance: If you have both Medicare and private insurance, Medicare may be the secondary payer, depending on the situation.
Spouses with separate insurance plans: Typically, your employer’s insurance is the primary payer, while your spouse’s insurance is secondary.
Veterans Administration (VA): VA coverage is not considered health insurance by CMS. If you have VA coverage, it will act as secondary insurance.
Employer-provided insurance: When an employee has employer-provided insurance, this is typically the primary insurance.
Military coverage: For military members, military insurance is typically the secondary insurance, and the primary payer may be other plans like TRICARE.

Steps to Resolve COB Issues

If you encounter problems with your COB or billing issues, follow these steps to resolve the situation:

1. Review Your Insurance Plans

Confirm coverage: Make sure you know the details of all your insurance policies (primary and secondary). Check your policy documents or call your insurers to verify which plan is primary and which is secondary.
Eligibility verification: Confirm that you’re covered by both insurance plans, and that the information is updated.

2. Contact Your Insurance Providers

Primary insurance: Call your primary insurance to confirm the correct billing and to clarify any confusion.
Secondary insurance: Contact your secondary insurance to check if they’ve processed the remaining charges.
Provide information: Be prepared to provide policy numbers, dates of service, and other relevant details.

3. Submit Necessary Forms

COB forms: If required, fill out and submit any COB forms that your insurance provider asks for. These forms help clarify which insurance should be billed first.
Supporting documentation: Provide any necessary documentation, such as Explanation of Benefits (EOB) from both insurers, medical bills, or claim status reports.

4. Keep Detailed Records

Document communications: Keep a record of all calls, emails, and written correspondence with your insurers and healthcare provider. Note the date, time, and names of representatives you spoke with.
Save paperwork: Retain copies of your insurance cards, medical bills, EOBs, forms, and any other documentation related to the issue.

5. Notify Siyan Clinical Corporation

Inform us when resolved: Once the issue is resolved, please notify Siyan Clinical Corporation immediately. This will allow us to update our records and proceed with accurate billing. Contact us via phone as listed below to confirm that the COB issue has been addressed and your coverage information is updated.

Conclusion

Coordination of Benefits ensures that your healthcare expenses are covered appropriately when you have more than one insurance plan. By following the steps outlined above, you can effectively resolve any COB issues that arise and ensure that your claims are processed correctly. Don’t hesitate to reach out to your insurers, healthcare providers, or even a billing professional to help with any complications.

Once resolved, please make sure to notify Siyan Clinical Corporation so we can update your information and prevent further issues.

For assistance or questions, feel free to contact us at: Siyan Clinical Corporation Phone: 707-206-7268 ext. 164