Coordination of Benefits “Cheat Sheet”

Coordination of Benefits, made clear

When a client has more than one insurance policy, filing to the wrong one first is one of the fastest ways to get a claim denied. Coordination of benefits (COB) decides which plan pays first, and the rules are not always obvious.

This free guide gives you a plain-language reference for the COB situations that come up most in a mental health practice. Keep it next to your desk and check it before you file.

What’s inside

• When Medicaid pays last, and why it’s the “payer of last resort”
• Why Medicare is not always primary when a client also has a commercial plan, and what actually decides it
• How Medicare Advantage and TRICARE fit into the order
• VA and ChampVA rules, including who pays when a veteran also has Medicare or a commercial plan
• The “birthday rule” for children covered by both married parents
• How to handle divorced parents, custody, and what the divorce decree does (and doesn’t) settle
• Married adults on two plans, young adults under 26, and college students on a parent’s plan plus a student health plan

Who it’s for

Therapists, counselors, and the billers who support them. If you’ve ever stared at a client’s two insurance cards and weren’t sure which one to send the claim to, this is for you.

A note from Susan

These rules are not absolutes. They’re governed by complex state and federal laws, and new legislation can change them. When you’re not sure which policy is primary, have the client request a formal COB determination from their payers. Remember: it is not the clinician’s responsibility to determine COB, only to follow it.

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