Simple Rules for Coordination of Benefits

October 18, 2023

Filed under: Uncategorized — dentalsupportteam @ 12:49 pm
pen and notepad with “Rules” written on it

When you decided to be in-network with dental insurance, you knew that it would attract more patients and help your business. However, working with these companies can get complicated. Case and point, a patient is covered by two insurance plans. You now have to do double the paperwork!

Coordination of benefits (COB) is essential if you want to be paid on time and correctly. Although there are more complex situations not discussed here, below are some rules that can help you get the basics of COB down.

Rule: Confirm Which Insurance Plan Is Primary and Secondary.

Before you file claims with any insurance company, you need to determine which policy is the primary and which is the secondary. Often, this varies by state, depending the regulations; in some states, the husband’s insurance is primary, but in others, primary insurance belongs to the spouse whose birthday occurs earlier in the year. If you aren’t sure, contact the state insurance commissioner’s office for guidance.

Rule: Verify Both Primary and Secondary Insurance Plans.

Not only should you distinguish between primary and secondary insurance plans, but you should also verify that the patient’s information is accurate and is actually covered by both plans prior to filing claims. Before the appointment, gather information for the patient’s plans and contact these companies to make sure you have all the correct group and plan numbers. Insurance verification takes time, but it ultimately saves you frustration and time in the long run.

Rule: Provide an EOB of the Primary to the Secondary Insurance.

Payments from the primary and secondary insurance policies are not divided down the middle. The primary insurance pays the full coverage amount, and then the secondary insurance kicks in. In most cases, the secondary requires a copy of the explanation of benefits (EOB) statement from the primary insurance. This acts like a receipt, showing that the first has already paid its share.

Rule: Get Help with COB

With so many opportunities to make mistakes in this complicated process, it’s natural if you and your team are feeling overwhelmed with having to deal with multiple insurances for just a single patient. The good news is that you don’t have to traverse this situation alone. You can outsource the legwork, meaning you don’t have to worry about multiple phone calls or additional paperwork—you simply get paid on time.

Ultimately, COB doesn’t have to occupy you and your team. When you understand some of the basic concepts and seek help from an experienced services company for support, you can manage any insurance situation your patients have and reap the rewards of accepting insurance.

About Dental Support Specialties

Dental Support Specialties has been in business since 2008 and has provided remote support services to dental practices around the country. We have the skills and experience to handle any insurance situation, including COB for multiple plans. If you have insurance questions or would like to work with us, don’t hesitate to contact our team. Just visit our Contact Us page here.

No Comments

No comments yet.

RSS feed for comments on this post.

Sorry, the comment form is closed at this time.