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Determining COB

  1. Default Determining COB
    Medical Coding Books
    If a patient has insurance coverage through both their Parent and their spouse, how do you determine which is primary?

    I have been told many different things, such as the "birthday rule", and whichever policy has been in effect the longest.

    Some clarification would be great. Also, is there a website that provides clarification on the subject?

    Thank in advance,

    Marcie S., CPC

  2. #2
    The "birthday rule" is sometimes correct but you have something quite different.
    Keep in mind that these practices are common among health insurance companies, but they are not governed by law. Practices may vary from one insurer to another. Read their policy carefully to make sure you understand how their insurance company handles dual coverage. If the policy language is unclear, ask for help from the insurer's customer service department

  3. #3
    Greater Orlando
    Default What do the insurance plans say?
    Have you queried the COB people at the two carriers/plans? What did they tell you?

    The Birthday Rule probably does not come into play, it's for cases where the patient has coverage under both parents insurance policies.

    Here the patient has coverage from his/her spouse and from one of his/her parents. Primary designation probably depends on whether the patient is a dependent of the parent or of the spouse.

    In terms of websites, the Ilinois Department of Insurance has one with some interesting examples:

    You might check your state's Department of Insurance website to see what guidance they can give you.
    Ron McKenzie, CPC-A
    Greater Orlando FL Chapter

  4. Wink
    Thanks so much for the great information!

    Marcie S., CPC

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