COB TERMS
What is a secondary payer?
What is, the insurance that pays after the primary and only covers remaining eligible costs.
Replace: “That’s not our problem. You’ll need to call them.”
What is “Let me help you understand who to contact and what to ask so this gets resolved faster.”
What does it mean when there's a duplicate payment on a claim?
What is, More than one payer or the same payer paid the claim more than once, creating a credit.
What is the birthday rule in COB?
What is, It determines primary coverage for a child—whichever parent’s birthday comes first in the calendar year.
Replace: “You must’ve done something wrong when you gave your insurance info.”
What is, “Let’s take a look together and see if there’s anything that needs to be corrected.”
What is the first step when a credit appears unexpectedly?
What is, Investigate which payer(s) paid and in what order to confirm if it was an error.
What is a primary payer?
The insurance plan that pays first before any other coverage applies.
Replace: “We can’t help you with your COB unless you call your insurance.”
What is, “Let me guide you through your coordination of benefits details so we can follow up with your insurance to keep the process moving.”
What can cause an insurance to request a refund?
What is, if it’s determined another payer (insurance) was primary.
What is tertiary coverage?
Insurance that pays after both primary and secondary plans have processed a claim.
Replace: “That’s just how insurance works. I can’t explain it.”
What is, “Insurance can definitely be confusing—let me break it down step-by-step for you.”
What can cause a credit that needs to be refunded?
What is, Two payers issued payment for the same claim.