Coordination of Benefits (COB) is a process that comes into play when you have more than one health insurance plan. It helps ensure that your medical expenses are properly covered when multiple insurers are involved. Your primary insurance pays first, and your secondary insurance covers costs that your primary plan doesn't. COB prevents overpayment by insurers and ensures you receive the maximum benefits available to you. More information is available here: Coordination of Benefits | FAQ
Troubleshooting Process
If you're experiencing issues with your Coordination of Benefits (COB), please proceed through the following:
Preparation Phase
1. Begin by thoroughly understanding your insurance coverage. Review your insurance policy documents, including the benefits, coverage limits, and COB provisions. This will help you have a clear picture of your coverage.
2. Collect all relevant information, including the details of the medical services or treatments you received, the healthcare providers involved, and any Explanation of Benefits (EOB) statements from your primary and secondary insurance companies.
Primary Insurance Phase
3. Contact your primary insurance company, the one responsible for your medical expenses, before any secondary coverage comes into play. You can usually find their customer service number on your insurance card or their website.
4. When speaking with your primary insurer, explain that you have secondary insurance and provide them with the details of your secondary insurance provider. Describe your situation or issue, such as denied claims or incorrect billing.
5. Ask your primary insurer for assistance in resolving the COB issue. They may need to coordinate with your secondary insurer to ensure proper claims processing. Be sure to note the names and contact information of the customer service representatives you speak with.
Secondary Insurance Phase
6. Next, contact your secondary insurance company. Again, use the customer service contact information on your insurance card or their website. Inform them of the COB issue and provide any details they request, such as EOBs or claim numbers.
7. Keep track of your interactions with both insurance companies. Document dates, times, and the names of representatives you speak with. Ask for reference numbers or case numbers for your records.
Evaluation and Outcome Phase
8. If the issue remains unresolved after contacting both insurers separately, consider requesting a three-way call between you, your primary insurer, and your secondary insurer. This can help ensure that both parties are on the same page regarding your coverage.
9. Review and Appeal: If necessary, carefully review any claim denials or decisions from your insurance companies. You may be able to appeal denied claims if you believe they should be covered. Follow the appeal process outlined by your insurers.
10. Seek Assistance: If the COB issue continues to be a problem, consider seeking assistance from a healthcare advocate, a patient advocacy organization, or your state's insurance department. They can provide guidance and support in resolving complex insurance issues.