Coordination of benefits form…what does it mean?

It is a very important form to fill out. For those of you with dual insurance coverage, you may have already gotten this form in the mail. According to the wisegeek: Coordination of benefits is a practice used to ensure that insurance claims are not paid multiple times when someone is insured under multiple insurance plans. The idea behind it is that someone on multiple plans might be tempted to submit claims to all of them, pocketing the excess cash.

Why does this matter at your pediatrician’s office? Again, the wisegeek says it well: Children can also be covered under coordination of benefits, with the “birthday rule” usually being used to determine which insurance company is the primary insurer. Under the birthday rule, the insurance company associated with the parent with a birthday earlier in the year would be the primary provider for the children. If Bob is born in January and Sue is born in March, Bob’s insurance would be the primary provider for their children.

What happens if you don’t fill it out? The insurance companies won’t know which plan is the primary plan for your child, and we have no way of looking up that information in our office. When we see your child in the office, that generates a claim that gets sent to your insurance company. Without this form those claims can get rejected, then we get a message saying your child “is not eligible for benefits so the claim is not covered”, and then our billing software may assume you are responsible for the full amount and will send you a bill.

It can take time to straighten out the confusion once that happens, and that means a delay in payments. Why is that important? Because we are a small business with 18 folks on our payroll…those folks need to be able to pay their own bills. A delay in payments can potentially impact their paychecks. So, a small form can have major consequences for us!

We hope this helps, and feel free to contact our billing office if you have any other billing or insurance questions: call them at 650-288-0600 option 7, or email them to billing@pwgrwc.com