Coordination of Benefits

Navigating the healthcare system can be tricky. It can be frustrating to determine if your insurance covers services and what your out-of-pocket costs are. Things get more complicated if you have more than one form of insurance.

Providing our patients with the best quality and affordable healthcare

Our customer service teams are available to help you navigate the billing process. Call customer service Monday – Friday, 8 am to 4 pm. Call customer service at 1-800-495-4915.

What is the Coordination of Benefits?

Coordination of benefits is the process insurance companies use to determine how to cover your medical expenses when covered by more than one health insurance plan.

Insurance companies determine the order before paying the medical bill. They do this to make sure each company pays the right amount.

Note: Just because multiple insurances cover you, doesn’t guarantee that all your services will be covered, which may result in a remaining balance you are responsible for.

To set up the coordination of benefits, you will need to contact your insurance company. Your insurance company will ask you to fill out a form disclosing any other health plans you may have in place. To gather this information your insurance company may:

send you a form in the mail
ask you to fill out a form online
request you call their customer service team

You should keep a copy of any documents for your records in case future questions arise. Remember, if you call the insurance company:

note the name of the customer service member you spoke to
record the case number or reference number for your call

If your coordination of benefit status is not up-to-date, your insurance could refuse to pay any claims. They may identify the amount owed as “patient responsibility.” This could leave you to pay the full cost of your visit. Getting coordination of benefits set up will prevent billing headaches later on.

Yes. Insurance companies may refuse to pay claims until receiving verification of health coverage. Insurance companies regularly check the coordination of benefit status. They may require it even when there is no other insurance coverage to coordinate. Providing information when requested will lead to a smoother billing process.

The most common methods for contacting your insurance company are:

by phone
through their website
through written correspondence

Review all insurance plan ID cards for policy number, group number, and names of those covered. Please note your policy number may also be the name member ID, participant ID, or another synonym.

Contact numbers for the insurance company are usually found on the back of the card.

When is Coordination of Benefits Needed?

Your insurance company may inquire about other coverage at any time. Some common situations that may prompt insurance to verify coverage/coordination of benefits:

When you have more than one form of medical insurance.
When a covered child has more than one form of health insurance.
- Usually, the policyholder with the earlier birth month is set as the primary.
When you have Medicare and another insurance plan through work.
- Medicare has a set of rules that determine when Medicare pays first and when it does not. Medicare will not pay claims if they have incorrect information about your coverage.
When insurance changes, or may change
When an accident occurs, such as, an auto accident
When insurance requires student status information.

When you add a baby to your policy.
- Insurance companies will often inquire about other coverage for mother and baby.
At the beginning of the year.
- Insurance companies will check to see if you have added another form of health coverage.

Accidents happen. After an accident, your health insurance company will ask about other types of coverage that may cover medical care. This includes: