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coordination of benefits

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kbar5

Junior Member
What is the name of your state? Michigan
If my COB is eliminated from my insurance and I have dual coverage (myself. and my spouses) do I have to report to the secondary ins about my primary coverage. The reason I ask is I am trying to determine if dual billing would be allowed seeing as the COB has been removed. I am in contract talks and my company is looking to elimnate the COB and i:m looking for reasons why we should keep it
 


ecmst12

Senior Member
And again, you are going to have to explain EXACTLY what that means. COB is not a 'feature' of insurance that can be added or removed at the employers option. It is just a term describing how a plan will handle claims if more then one policy covers the same patient.
 

kbar5

Junior Member
the company is telling us they no longer are going to coordinate benefits with a secondary ins co. I do understand how a COB works. From your reply I am assuming that a company cannot opt out of doing COBs. To give a better understanding they do not want to pay as a secondary ins,example my wifes ins pays 80 perct mine right now would pick up the 20 perct, they are nowing looking to stop paying the 20. that is why I asked if they drop the COB could you double bill which is what the COB is supposed to stop hence saving money on your premium
 

ecmst12

Senior Member
Ok that is not DROPPING the COB. It's simply CHANGING the COB policy. You can bill the secondary insurance but it sounds like they would not pay anything. But you would have to see the complete COB policy to find out if they would EVER pay and under what circumstances. For example, if a service is not covered by the primary but covered by the secondary, would they pay? If a service is covered at 50% by the primary but 80% by the secondary, would they pay 30%?
 

kbar5

Junior Member
Thanks for your help ecmst12 that makes a little more sense of wht they are trying to do

thanks again
 

momm2500

Member
Cob

what they are trying to put in the plan is the way coordination of benefits is administered in the plan. what they are trying to do is put the wording 'carve-out' in the plan. what that means is that if the primary insurance pays more than what the secondary would pay without other insurance coverage, then they wont pay anything.
example is:

primary insurance plan pays 80% for a service.
the secondary plan pays 80% also. then it cancels out the payment from the secondary.

if primary pays 50% for a service and the secondary plan pays 80%, then the secondary plan will pay up to their normal liability which means they will pay 30%.

this is a way that the plan saves money.
 

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