Insurance term
Coordination of Benefits
Definition
Coordination of benefits (COB) is the set of rules that decides which plan pays first, and how much the second plan pays, when a patient has two dental plans.
Why it matters for the front desk
The primary plan must be billed first, then the secondary with the primary's EOB attached. For children covered by both parents, many plans use the birthday rule: the parent whose birthday falls earlier in the calendar year has the primary plan. Some secondary plans have a non-duplication clause and pay little or nothing. Setting the order correctly at check-in prevents rejected claims.
Related terms
- EOB (Explanation of Benefits) An EOB is a statement from the insurance payer that explains how a claim was processed: what was billed, allowed, paid, adjusted and left for the patient.
- Eligibility Verification Eligibility verification is the process of confirming, before an appointment, that a patient's dental coverage is active and what it will pay for.
- Coinsurance Coinsurance is the percentage of a covered procedure's cost that the patient pays after the deductible, with the plan paying the rest.