Understanding Dental COB Complexities

Hi, this is Amber Darst, Solutions Manager here at MOS and for this podcast, I’ll be discussing the complexities of coordination of benefits and dental insurance.

So, what is coordination of benefits or COB for short?

Well, this kicks in when a patient is eligible for more than one dental insurance plan. The purpose is to prevent overpayment or duplication of benefits while claims are processing. It’s also worth noting that state laws and regulations oversee COB to ensure compliance.

00:37 Key Rules for COB

Here are the key rules for COB as per the guidelines of the ADA.

• First, we have employee or main policy holder.

When both plans have COB provisions, the plan where the patient is an employee or considered the main policy holder takes precedence, and the plan where the patient is a dependent becomes the secondary.

• Second, we have current employment.

If a patient has coverage through their employer, that plan is considered the primary over any COBRA or retiree plans.

• Next, we have more than one employer plan.

 When a patient has plans from multiple employers, the plan with the longest coverage history is considered the primary.

• Then we have dependent children.

 Overlapping coverage for dependent children follows the birthday rule, with the parent having the earliest birthday in a calendar year being considered as the primary.

• And then last, we have medical and dental plan.

 If a patient is covered by both medical and dental plans, the medical plan takes precedence.

01:43 Different Ways COB can be Used

Now, let’s explore the different ways COB can be utilized.

• 1st we have traditional.

 This allows the beneficiary to avail 100% of expenses when combining their primary and secondary plans.

• Next we have maintenance of benefits.

 Covered charges are reduced by the primary plan’s payment, followed by applying the plans deductible and coinsurance criteria. The beneficiary shares part of the cost.

• Then we have carve out.

 This method computes normal plan benefits, then subtracts the primary plan’s payment.

• Next, we have non-duplication of COB.

This is common in self-funded plans and assesses whether the primary carrier paid more than the secondary carrier would have.

• Network plan write-offs.

 Write-offs are calculated based on the difference between the dentist fee and the total plan and patient payments. It’s crucial that write-offs are done correctly.

• And then last we have Medicaid and Medicare.

 These programs interact with COB with third party resources, paying before Medicaid for eligible patients. Medicaid is typically considered secondary.

Navigating all the ins and outs of COB can be intricate, but understanding the rules and types is essential for dental practices. Remember that knowing your patient’s primary and secondary insurance is key, and if you want a smoother experience, consider enlisting the help of a professional dental billing company such as MOS.

 And that’s all on this.

 Thanks for listening in.