What is Coordination of Benefits?
Health insurance can be confusing and gets more complicated if you have more than one form of insurance coverage. Some insurance companies request this information from patients every year and some insurance companies only request this information if they discover you may have had an accident or injury or may be covered under another health insurance plan.
Coordination of benefits is a process insurance companies use to determine how to cover your medical expenses when:
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you're insured by more than one health insurance plan
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have a work-related injury
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vehicle or property accident or injury
Your insurance company will use the information you provide to them to decide which plan is responsible for covering your medical expenses. Your health insurance company will usually send you a notice or letter requesting information from you if they need to determine if another payer may be responsible for covering your medical expenses. It is important for you to contact your insurance company to update your information or share with them any accident or injury details because you may be responsible for your medical expenses if they do not receive the information.
Our Patient Financial Services team is here to help you understand the billing process and answer your questions. You can send ask your questions through MyChart or by calling our Patient Financial Services team (insert link to PFS phone number and hours).
FAQ
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How do I contact my insurance company to update my coordination of benefits?
The most common ways to contact your insurance company are:
- by phone
- through their website
- through written correspondence
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How should I handle a coordination of benefits request for my health insurance?
To set up coordination of benefits, you will need to contact your insurance company. Your insurance company will ask you to fill out a form disclosing any other health plans you may have in place. To gather this information your insurance company may:
- send you a form in the mail
- ask you to fill out a form online
- request that you call their customer service team
You should keep a copy of any documents for your records in case questions come up in the future. Remember, if you call your insurance company:
- note the name of the customer service member you spoke to
- record the case number or reference number for your call
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What happens if the coordination of benefits is not completed?
If your coordination of benefits information is not up to date, your insurance company could refuse to pay your claims. They may identify the amount owed is "patient responsibility" and could leave you to pay the full cost of your health care charges.
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What if I don't have other insurance coverage or no one else is responsible for my accident or injury?
You will still need to contact your insurance company and let them know that you do not have any other insurance coverage or no one else is responsible for your accident or injury. Your insurance company may not process your claims unless they receive this information from you, and you may be responsible for your medical expenses until they receive this information.