We are happy to provide primary and secondary billing services to those clients with dual coverage and verify active coverage with Coordination of Benefits (COB) in place for both plans provided at the time of intake.
Clients who opt to use dual insurance coverage for their sessions should make sure they check with both insurance companies prior to scheduling their initial session to understand their financial responsibilities when using both plans and verify they have set-up their Coordination of Benefits (COB).
Depending on contracted rates with our insurance companies for allowed amounts, there can be an increase in your balance owed after both insurance plans have processed.
Claims billed to a Secondary plan are submitted once the Primary plan has processed, both plans must have their Coordination of Benefits (COB) in place prior to the session and indicated via online verification. Failure of claims due to COB issues will be the responsibility of the client – see detailed outlined in Financial Responsibilities subsection below.
UNDERSTANDING COORDINATION OF BENEFITS (COB)
Coordinating benefits means you have notified both of your insurance plans identifying which plan is Primary and which is Secondary. If you do not know which is your primary plan, you should contact either health plans to verify which plan is primary. There should be a customer service number provided on the back of your insurance card.
We abide by the following COB standards to determine which insurance plan pays first (primary carrier) and which pays second (secondary carrier).
Briefly, these rules are as follows:
- ACTIVELY WORKING MEMBER WITH INSURANCE: A member is primary on the plan in which he/she is the subscriber versus the plan in which he/she is a dependent. When a member is the subscriber on more than one plan, when both plans have a COB provision, the plan with the earliest start date pays first (primary).
- DEPENDENT WITH DOUBLE COVERAGE AND MARRIED PARENTS: When a dependent is double-covered under married parents’ health plans, the primary plan is the coverage of the parent with his/her birthday earlier in the year, regardless of their actual age. This standard is called the “Birthday Rule.”
- DEPENDENT WITH DOUBLE COVERAGE AND DIVORCED PARENTS: When dependent children are double-covered by divorced parents, coverage depends on any court decrees. Generally, if the court decrees financial responsibility for the child’s healthcare to one parent, that parent’s health plan always pays first. If there are no court decrees, the plan of the parent with custody is primary.
FINANCIAL RESPONSIBILITIES
We do not split statement balances among parental court ordered responsibilities or parenting plans. The primary custodial parent or parent signing the financial responsibility form during the registration process will be responsible for any amount owed. We are happy to provide a e-statement to the paying parent to submit to the other parent for their records and direct reimbursement back to the other parent.
Children 13+ must have signed release of information to forms to discuss any appointment, billing or insurance information with either parent.
Session claims that are returned or denied by your insurance for due to failure to Coordination of Benefits, will be changed to a private pay rate and billed to you directly and will be your responsibility to pay in full. We are happy to provide you with a Superbill to send to your insurance for reimbursement on services paid by you.
There is a timely claim filing requirement with all insurance claims, therefore, if you are covered by more than one plan and your COB is in place, you should promptly report to our billing department at 425.869.2644, ext. 18 along with any changes in your coverage.