Coordination of Benefits (COB)

Please contact the billing department at Kids Central Pediatrics by calling
(865) 298-5017

Kids Central Pediatrics wants to ensure each of our patients receives the maximum allowed benefit from their health care insurance coverage when they have multiple insurance companies. One way of doing this is making sure your Coordination of Benefits (COB) is updated with each health care plan. This guide is to assist in what COB is, why it is important, and how you can make sure your COB information is correct.

What is COB?

COB applies to a person who is covered by more than one health care plan. COB refers to how we ensure that patients receive full benefits from their insurance carrier(s) and help prevent denial of payment for services. When your insurance denies a claim, you’re responsible for payment until they receive updated COB and release payment.

Dependent Child/Parent not Separated or Divorced. Except as stated below, when this Plan and another plan cover the same child as a Dependent of different persons, called “parents”:

• The benefits of the plan of the parent whose birthday falls earlier in a year are determined before those of the plan of the parent whose birthday falls later in the year.
• If both parents have the same birthday, the benefits of the plan that covered one parent longer are determined before those of the plan that covered the other parent for a shorter period of time.
• However, if the other plan does not have the rule described in the first bullet immediately above, but instead has a rule based upon the gender of the parent, and if, as a result, the plans do not agree on the order of benefits, the rule in the other plan will determine the order of benefits.

Dependent Child/Separated or Divorced.

If two or more plans cover a person as a Dependent child of divorced or separated parents, benefits for the child are determined in this order:

• The plan of the parent with custody of the child.
• The plan of the Legal Spouse of the parent with custody of the child.
• The plan of the parent who does not have custody of the child.

However, if the specific terms of a court decree state that one of the parents is responsible for the healthcare expenses of the child, and the entity obligated to pay or provide the benefits of the plan of that parent has actual knowledge of those terms, the benefits of that plan are determined first. The plan of the other parent will be the secondary plan. This paragraph does not apply to any claim determination period or Benefit Year when any benefits are actually paid or provided before the entity has the actual knowledge.

Dependent Child/Joint Custody.

If the specific terms of a court decree state that the parents will hare joint custody, without stating that one of the parents is responsible for the healthcare expenses of the child, the plans covering the child will follow the order of benefit determination rules.

Why is COB important?

Your insurance carrier may have the incorrect coordination of benefits filing order for you. If you have two health insurance policies or coverage, each type of coverage is called a “payer.” When there is more than one source of coverage, “coordination of benefits” rules decides which one pays first. The “primary payer” pays what it owed on your charges first, and then sends the rest to the “secondary payer” to pay. The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary. The secondary payer only pays if there are costs the primary insurer did not cover.

When do I update my COB?

We depend upon your help for Kids Central Pediatrics to bill for your health care services correctly. To streamline claim processing and reduce the number of denials of payment related to the coordination of benefits, you must contact your insurance carrier about any changes in your health insurance due to you, your spouse, or a family member’s current employment or coverage changes. It is also important to confirm your existing coordination of benefits information or update it when your plan renews each year. You must also contact the other insurance plan and confirm the filing order as primary or secondary.

How do I update my COB?

It is very important that your COB information is updated and accurate before your next visit.  Call the member service phone number on the back of your insurance card to update your insurance coordination of benefits information.