Navigating Your Insurance: A Simple Guide to a Coordination of Benefits (COB)
If you have more than one health insurance plan, your insurance companies require something called a Coordination of Benefits (COB) to determine which plan pays first. This needs to happen even if you know what plan is the “primary plan”.
Only you, the client, can complete this process. Healthcare providers cannot do this on your behalf. Until the COB is confirmed, your insurance will not process or pay medical claims. This guide explains when a COB is needed and exactly how to complete it.
The Financial Risk
Taking immediate action is critical to protect yourself from unexpected medical bills. Failure to complete a COB is one of the most frequent causes of claim denials and delayed payments.
If your COB is not completed:
Your insurance company will refuse to process your claims.
You will be held financially responsible for the full cost of all services.
When to Complete a COB
You need to complete a COB if any of the following apply to you:
You have both primary and secondary insurance.
Your insurance changed within the last 12 months.
You are covered under a spouse or parent's plan.
Claims are being denied for "COB required" or "other coverage on file."
Your insurer or provider has requested it for payment authorization.
4 Steps to Complete Your COB
Step 1. Call Your Insurance Company
Call the Member Services number on the back of your primary insurance card. Some insurance companies also allow you to complete this process through their online member portals.
Step 2. Start the Conversation
Once connected to a representative, use this exact language: "I am calling to complete a Coordination of Benefits (COB). I need to confirm my primary insurance and check if you have any other coverage for me on file."
Ask the representative to process the COB as quickly as possible. This process can sometimes take over 10 business days.
Step 3. Provide Your Information
Answer the representative's questions accurately. Have the following details ready:
Your full name and date of birth.
Your member ID number.
Confirmation of whether you have any other insurance coverage.
The name, policyholder details, and start and end dates of any other active insurance plans.
Step 4. Get Confirmation
Before ending the call, ask the following questions:
"Can you confirm that my Coordination of Benefits is now complete, and what the reference number is?"
"Can I request an expedite of this Coordination of Benefits?"
"What is the effective date of this COB update?"
Always request a reference number for the call. Provide this reference number to our office so we can track the update.
What to Expect Next
Once you complete the call, it takes time for the insurance company systems to update.
Updates generally take 7 to 20 days to process.
Claims submitted before the update is finalized will need to be reprocessed (This is the part we do).
You may see temporary claim denials during this waiting period. A new explanation of benefits will be mailed explaining the cost sharing with your insurance.
At Desert Clover Psychiatry, our goal is to ensure your care is not interrupted by administrative delays. Completing this process protects you financially and allows us to focus entirely on your clinical care. Whether you are engaging in Specialized Therapeutic Programs like CBT-I, utilizing genomic testing, or maintaining your Medication Strategy, having your insurance correctly configured is essential to ensure cost dosnt’t become a barrier to your care.