If you’re on a health insurance plan, there are many terms you need to understand. One of these is the coordination of benefits or COB. This article explains what coordination of benefits is and how it works. It also covers important COB rules that may impact your coverage if you’re on Medicare or any other insurance plan.
1. Understanding COB
COB is a provision that says your insurance company will review and pay your claims only after the primary payer, has paid its portion of the bill. While COB benefits are intended to limit administrative costs, a primary payer is the patient’s last connection to the health care system when all claims are paid. This means that if your plan is approved by Medicare or any other insurance plan, your employer is required to pay any portion of your COB.
COB review is the process of coordinating the billing of services between:
- Your health insurance plan
- Private preferred provider organization doctors (PPO)
COB is a critical part of how health insurance works. Why? It helps you understand exactly what services your provider will pay for, how much they’ll pay, and when they’ll pay for them.
2. How does COB work?
COB refers to an agreement between two insurers. The agreement determines which insurer will pay first and how much of the medical bills the second insurer will cover. For example, say you have medical coverage through your employer and your spouse has medical coverage through her employer.
3. COB rules that could affect your coverage
COB is a concept that your health insurance provider must use when writing your plan’s coverage to ensure that the costs of covered medical care are shared between you, your spouse, and your dependents. Depending on your health plan’s type, you may have a 60-day deadline after which providers must change your coverage or pay a late fee.
Coordination of benefits is a two-step process.
First, Your health insurance plan must develop a list of the health services and supplies that each of you will receive under the plan.
Second, your health insurance provider must collect, document, and send copies of these services and supplies to the insurance company and to you. Your health insurance provider must then send you a list of the covered services and supplies before the last day of your coverage period, either 60 or 90 days from the date the services and supplies were collected.
Coordination of benefits is one way you can ensure you’re getting the most out of your health insurance plan. Make sure to educate yourself on how the coordination of benefits works and what it means for your coverage. COB rules can change from time to time, so it’s a good idea to stay up-to-date on the latest news about this topic.
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