Coordination of Benefits (COB) determines what in healthcare insurance?

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Coordination of Benefits (COB) is a crucial process in healthcare insurance that addresses situations where an individual is covered by more than one insurance policy. The primary function of COB is to determine the order in which these policies will pay for claims, known as the primary and secondary payer process. This is essential to ensure that the total reimbursement does not exceed the amount of the claim and that each insurer contributes appropriately according to their contractual obligations.

When multiple policies are in place, one policy is designated as the primary policy, which pays its benefits first. The secondary policy pays the remaining balance, up to the limits of what it covers. This helps in preventing overpayment and ensures that the patient does not face excessive out-of-pocket costs. By clearly establishing which policy pays first, COB effectively manages the complexities of multiple insurance coverage, ensuring seamless access to healthcare benefits while minimizing disputes between insurers and allowing for a systematic approach to billing and payment.

Other choices relate to healthcare coverage but do not specifically capture the essence of COB. Determining which insurance covers the entire bill, coordinating with Medicaid, or identifying which services are eligible for coverage are all part of broader discussions about health insurance policies but do not focus on the specific mechanism of how multiple policies interact when covering the same

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