Coordination of benefits
Coordination of benefits (COB) is a crucial process in health insurance that ensures patient families don't receive duplicate payments for covered services when they have multiple plans. This might occur if you have an additional health insurance coverage through your spouse, another employer or a government-sponsored program like Medicaid, Medicare or Medical Assistance. COB rules determine which plan is "primary" for different family members and how much each plan contributes to covering expenses. This can be important for patients because it:
- Reduces your out-of-pocket costs - By preventing duplicate payments for the same medical services, COB ensures you don't get stuck with unexpected bills.
- Increases transparency - By clarifying which plan is responsible for what, COB helps patient families understand their benefits and make informed decisions about their healthcare expenses.
- Ensures complete coverage - COB ensures you receive the full benefits you're entitled to from all your plans, maximizing your coverage.
- Avoids confusion and delays - By clarifying which plan pays first, COB prevents delays in receiving care or reimbursements.
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How do I contact my insurance company?
Whether you can complete coordination of benefits information online will depend on your insurance company and what options they provide. Contact information for many common health plan providers is listed below for your convenience.
Blue Cross Blue Shield
By phone: 1-800-451-0287
COB form - Complete and submit the web form.United Healthcare
By phone: 1-866-801-4409
COB form – complete and fax to 801-567-5498 or mail to the address on the back of your member ID cardCigna
By phone: 1-800-244-6224
Aetna
By phone: 1-877-512-0363
COB form – complete and fax to 866-474-4040 or mail to:Aetna
P.O. Box 981106
El Paso, TX 79998-1106Humana
By phone: 1-866-427-7478
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What is needed from patient families for coordination of benefits?
Your insurance company will often require you disclose any other health plans you may have. They may require a form requesting the information via mail, ask that you fill out the information online, or request that you call them directly. To complete the coordination of benefits requirement, you will need to contact your insurance company and provide the requested information.
You should keep a copy of any documents exchanged for your records in case any questions arise in the future. If you contact the insurance company on the phone, you should record the representative’s name and the call reference number. -
What happens if I do nothing?
If the coordination of benefits status is not updated, it is possible your insurance company will refuse to pay any claims. They may identify the amount owed as patient responsibility, leaving you with the full balance for your visit(s). Complying with your insurance company’s coordination of benefits request will save you time and prevent confusion between you, your insurance company and healthcare provider.
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What if I only have one health insurance plan?
Even though you may only have one health insurance plan, your insurance company may refuse to pay claims until verification is received. Please ensure you complete the required coordination of benefits even when there are no other coverages to coordinate.
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How do I contact my insurance company regarding coordination of benefits?
Your insurance company may have different methods for contacting them regarding coordination of benefits. The most common methods are by phone, online portal, mail or fax.
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What type of information is usually required?
While the information required may vary between health insurance companies, common documents/information is:
- Full name of subscriber
- Date of birth for subscriber
- Member ID and Group Number
- Beginning and end date of coverage
- ID card(s) from all other health insurance plans
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How often is coordination of benefits required?
Your insurance company may require you to update coordination of benefits information once a year, even if you don’t have more than one insurance coverage.