Coordination of Benefits (COB)

Navigating the health care system can be tricky. It can be frustrating determining if your insurance covers services and what your out-of-pocket costs are. Things get more complicated if you have more than one form of insurance.

Our customer service teams are available to help you navigate the billing process. Call customer service Monday – Friday, 8 am to 5 pm.

What is Coordination of Benefits?

Coordination of benefits (COB) is part of the insurance payment process. It is how insurance companies decide who covers the cost of your care in a given situation. Insurance companies follow general principles to establish the order each company will pay.

  • Your primary payer covers the largest share of the cost.
  • Secondary payer covers some of the remaining cost.

Insurance companies determine the order before paying claims. They do this to make sure each company pays the right amount.

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 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 insurance company:

  • note the name of the customer service member you spoke to
  • record the case number or reference number for your call

If you coordination of benefit status is not up to date, your insurance could refuse to pay any claims. They may identify the amount owed as “patient responsibility.” This could leave you to pay the full cost of your visit. Getting coordination of benefits is set up will prevent billing headaches later on.

Yes. Insurance companies may refuse to pay claims until receiving verification of health coverage. Insurance companies regularly check coordination of benefit status. They may require it even when there is no other insurance coverage to coordinate. Providing information when requested will lead to a smoother billing process.

The most common methods for contacting your insurance company are:

  • by phone
  • through their website
  • through written correspondence

When contacting your insurance company you will need to have:

  • ID cards from all health insurance plans
  • Full name and date of birth for each person on your plan covered by other insurance

Review all insurance plan ID cards for policy number, group number, and names of those covered. Please note your policy number may also be name member ID, participant ID, or another synonym.

Contact numbers for the insurance company are usually found on the back of the card.

sample of aetna insurance card - front   sample of aetna insurance card - back

When is Coordination of Benefits Needed?

Your insurance company may inquire about other coverage at any time. Some common situations that may prompt insurance to verify coverage / coordination of benefits:

  • When you have more than one form of medical insurance.
  • When a covered child has more than one form of health insurance.
    • Usually, the policyholder with the earlier birth month is set as the primary.
  • When you have Medicare and another insurance plan through work.
    • Medicare has a set of rules that determine when Medicare pays first and when it does not. Medicare will not pay claims if they have incorrect information about your coverage.
  • When you add a baby to your policy.
    • Insurance companies will often inquire about other coverage for mother and baby.
  • At the beginning of the year.
    • Insurance companies will check to see if you have added another form of health coverage.

Accidents happen. After an accident, your health insurance company will ask about other types of coverage that may cover medical care. This includes:

  • liability insurance (in the case of a car accident)
  • workers' compensation insurance (in the case of a work-related accident)

How insurance companies handle cases depends on state laws and types of insurance involved.

How Do I Contact My Insurance Company Online?

SSM Health has compiled contact information for several insurance providers for your convenience.

Note: completing coordination of benefits information online depends on the options your insurance company provides.

  • Account Login
  • Individual & Marketplace Plans: 866-514-4194 (TTY: 711)
  • Medica/WellFirst Employee Health Plan: 877-274-4693 (TTY: 711)

SSM Health is here to help you get the care you need and make the most of your health care dollars. Our customer service teams are available to answer any questions about this process. Call customer service Monday – Friday, 8 am to 5 pm.

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