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• My insurance denied claims because of “another payer’s responsibility” or Coordination of Benefit (COB) issue. What should I do next?

My insurance denied claims because of “another payer’s responsibility” or Coordination of Benefit (COB) issue. What should I do next?

Claims for medical services will be denied by the medical insurance provided to the medical office as primary, if is listed as secondary policy with that insurance. Also, your medical insurance provider will NOT process your claim if they have outdated or missing COB information, determine another policy is active or another insurance plan hasn’t provided verification of coverage.

What is a Coordination of Benefits (COB)?

Coordination of Benefits is the process insurance companies use to determine which plan pays first when a patient has more than one health insurance policy. Is very important to consider that this is NOT a process your provider office makes or participates. You need to take actions with your child’s medical insurance to resolve the issue promptly in order to avoid bills and financial issues.

What You Need to Do?

To resolve any issue with claims and have any deny claim reprocesses, or to prevent issues with future claims, please contact your insurance company as soon as possible and take the following steps:

1. Call the member service number on the back of your child’s insurance card.
2. Ask to update or verify your Coordination of Benefits (COB) information.
3. Let them know:
   1. Whether your child has any other insurance coverage.
   1. Which policy should be considered primary or secondary.
4. Request that they reopen and reprocess all denied claims once the COB is updated.
5. Note the name of the representative that you spoke with and most importantly, ask and record a call reference number or case number for your call.
6. Contact the providers office to update outstanding claims status with the call reference number and any actions that is needed to resolve the issue. You can use your patient portal to send a message to the Admin billing team. If the insurance, that denied the claim, is your child’s secondary insurance, make sure you provide a picture of the front and back of your primary insurance card as soon as possible.  

If your child’s insurance does not receive verification from you or your child’s coordination of benefit status is not up to date, your insurance could refuse to pay any claims and will identify the amount owed as “patient responsibility.” This could leave you to pay the full cost of your visit and deal with collections settings as per your agreement with the practice.

Our office is happy to assist you with any additional information you may need to resolve the issue promptly.

How to contact your Child’s Insurance Company:

The best way to contact your child’s medical insurance’s member services is to look on your child’s member ID card or the insurance’s website to find the appropriate number. Consider calling off-peak hours (e.g., early morning or late afternoon/early evening, Wednesday or Thursday) to potentially reduce wait times. If you have an agent or broker, sometimes they are helpful with questions about your coverage, enrollment, or renewal but, keep in mine that the policy terms are what decide outcomes and clarification must be provided by the guarantor directly with the insurance company.