Coordination of Benefits

Written by  Jean Gray
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Coordination of benefits refers to the order in which multiple plans will pay for a covered event.  Usually whoever pays first, pays the lion’s share.  That’s why there is such a to-do about it, nobody wants to be first.

With both parents/spouses working, you can wind up with dual coverage – nice problem to have.  Some plans will flat out stipulate that if there is another plan, they will pay last.  Or for dependant children the order of payment can be determined by going with the eldest parent’s plan, or by whose birthday occurred first in the calendar year.  There are others methods too, the point being there is a sequential order to who pays first, second and third.

Third?  Some ancillary accident and excess medical expense plans stipulate they pay last and only the left over ‘up to’ amounts.  It may seem like somehow you got gypped when your $5,000 accident plan only pays $300 – but the bill gets paid and that’s what it’s there for.

So why is it important to know, “who’s on first”?  If you go to the hospital, and list the last to pay insurance as the first to pay … you can be in for some fun times straightening it all out.  It is one headache you can (and which you want) to avoid.  And also so you don’t try to get a last to pay to pick up expenses it won’t. You'll want to make sure you see a physician in the right network, etc.

If you have the problem of multiple insurance coverage, but don’t know who pays first, just call your plan(s) and they will tell you.

Last modified on Sunday, 29 April 2012 19:29

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