Coordination of Benefits: What does that even mean?

What’s worse than dealing with one dental insurance? DEALING WITH TWO!

Understanding how these two policies work in relation to each other is crucial for presenting accurate treatment. We have been getting so many questions lately on what each COB option means, how to enter it into the software, and how to calculate patient estimates. We are diving into all of your questions in this weeks blog post!

So, lets dig in on Coordination Of Benefits:

1. Standard: Secondary insurance pays based on the remaining balance after primary pays, but not more than it would have paid as primary or more than the charged amount.

2. Basic: Secondary pays either the amount that it would have paid in the absence of any other coverage or the allowed amount minus what primary paid. Whichever is less.

3. Carve Out AKA Non Duplicating: Secondary insurance will not contribute to patient care if Primary makes a contribution.

Clear as mud right? Lets go over some examples.

Standard: John presents for a filling procedure. The dental office charged $250 for this service. Primary paid 80% of their allowable fee. Their allowable fee was $200. This makes the primary payment $160. Secondary will pay 50% of their allowable fee. Their allowable fee is $220. So their payment would be $110 -OR- $90 (the remaining after primary paid). Whichever is less.

OFFICE FEES: 250

PRIMARY PAID: 160

SECONDARY PAYS: 110 90

Basic: John presents for a filling procedure. The dental office charged $250 for this service. Primary paid 50% of their allowable fee. Their allowable fee was $220. This makes the primary payment $110. Secondary will pay 50% of their allowable fee. Their allowable fee is $200. So their payment would be $100 -OR- $10 (110-100). Whichever is less.

OFFICE FEES: 250

PRIMARY PAID: 110

SECONDARY PAYS: 100 10

Carve Out: The dental office charged $250 for this service. Primary paid 50% of their allowable fee($200). This makes the primary payment $100. Secondary will pay nothing because primary made a payment. Secondary will only pay if primary is maxes or if the service is not covered by primary

OFFICE FEES: 250

PRIMARY PAID: 100

SECONDARY PAYS: 0