When it comes to dental billing, so many different terms are used that acronyms have become commonplace. For instance, most billers use DOS for dates of service, PCH for periodontal charts, and FMX for full mouth x-rays. Another common acronym is COB, which can be harder to understand. In the following, we will review just what COB means.
What Does COB mean?
COB specifically stands for Coordination of Benefits. When a patient is covered by more than one insurance plan, those plans need to coordinate the benefits they provide so that each carrier pays the correct amount.
When does COB apply?
COB applies when a patient is covered by primary and secondary coverage (and occasionally a third or fourth coverage).To coordinate benefits, the correct primary and secondary coverage must be identified. Depending on the circumstances, this process can be easy or quite difficult.
How do I coordinate benefits for an adult patient?
There is no standardized way to coordinate benefits. It depends on a variety of circumstances. Here are some scenarios for adult patient COB:
If the patient is the subscriber on both plans, the one with the earliest effective date is primary.
If the patient is the subscriber on one plan and the dependent on another, the plan in which they are the subscriber is primary, and the plan in which they are the dependent is secondary.
If the patient is a federal employee, their federal medical plan will be primary (federal medical plans have a dental rider) and their federal dental plan will be secondary.
How do I coordinate benefits for a pediatric patient?
Just as with adult patients, there is no standardized way to coordinate benefits for pediatric patients. Pediatric coordination of benefits can be especially difficult as numerous circumstances can affect primary and secondary coverage determination. Here are a few scenarios:
If the patient lives in a two-parent household the “birthday rule” applies and the plan in which the parent has the earliest birthday month is primary.
If the patient’s parents live apart the plan of the parent who lives with the child is primary unless there is a court order stating otherwise.
If the patient lives with a parent and step-parent the plan of the parent who lives with the child is primary, the plan of the other biological parent is secondary, and the plan of the step-parent may be a third coverage (unless a court order states otherwise).
How do insurance companies coordinate benefits?
The primary insurance processes the claim as normal. The secondary insurance then reviews the primary EOB and pays any remaining amount of coverage. Most secondary plans will only process the claim once the primary plan has been paid and an EOB is provided.
Why is COB important?
Coordination of benefits is important because it ensures the claim is paid properly. If benefits are not coordinated it can lead to complications further on. When COB is incorrect, one plan may overpay the claim. This will result in an account imbalance and a refund due to the carrier. It can also cause an imbalance in the patient’s portion and cause them to be dissatisfied with their care.
Practicing proper coordination of benefits is essential for any dental biller so that claims are billed correctly, accounts remain balanced and patients are satisfied. If your office is struggling with COB, consider partnering with eAssist. Our Success Consultants are highly experienced dental billers who ensure your benefits are properly coordinated every time. To learn more, schedule a consultation here.
