The dental care industry is known for its many terms and concepts that need to be clearly understood by the dental team. Some terms might even sound similar, but they can be completely different. Understanding what COB vs EOB is important to know for the dental team.
Before attempting to comprehend what COB vs. EOB is all about, one needs to thoroughly understand the meaning of these individual terms.
COB, or Coordination of Benefits, enables the dental team to determine how treatments can be covered by insurance when a patient has multiple insurance plans. This can help insurance companies determine how to handle reimbursement responsibilities to the practice based on the patient's insurance plan.
In the case of a patient with dual coverage, one needs to determine which plan has primary payment responsibility and which plan acts as the secondary plan. This provision helps the dental team ensure that treatment for a patient gets covered for claims by identifying health insurance benefits.
Moreover, it helps to coordinate the payment process by ensuring that the primary insurance payer needs to cover the claim first, and the secondary insurance payer will cover any balance amount that needs to be paid.
COB is an effective mode of covering healthcare expenses for a patient with more than one insurance plan. The objective is to make sure that all expenses associated with the treatment are covered within the scope of the insurance policy. The amount covered by the primary and secondary plans cannot exceed the amount of the total bill.
Coverage needs to be coordinated when a patient is covered by two or more dental plans. This can happen when both spouses are covered by the employers or have personal insurance plans. When it comes to kids, the primary insurance company will usually be decided by the birthday rule. The plan that covers a parent or a guardian whose birthday comes first in the calendar year will be deemed the primary insurance company.
Coordination of Benefits helps to confirm that the secondary insurance company gets eligibility data and claim submissions for balance payments.
Coordination of benefits can have a few disadvantages when the dental team applies the same for a patient. Various insurance plans for patients can be complex for the dental team, who might make errors in administering them. It also involves further paperwork and documentation.
COB takes additional time as the dental team needs to comprehend all the details of multiple plans that the patient has. The team needs to carefully understand the respective guidelines and coverage details, and associated conditions.
From a patient's point of view, there can be an element of cost consideration. A patient must analyse all the benefits of having various health insurance plans. There can be costly combined premiums, copayments, and deductibles.
Besides coordination of benefits, the dental practice needs to handle explanation of benefits or EOB. What exactly is EOB from the point of view of a practice or a patient?
An EOB is a document that a patient receives from the insurance company once dental treatment has been completed. It is a document that highlights the solutions or procedures that are included within the benefits that the insurance plan provides to the patient.
It will also include any procedures or treatment rendered to the patient and not covered by the insurance plans, and the reasons for non-coverage.
The EOB offers the patient all the vital information that could be needed. These include:
The explanation of benefits offers comprehensive details on how the insurance coverage is applied and how the claim is processed. The document needs to be handed in at the time of receiving the ‘patient billing statement.’
The patients can thus know how the procedures and services have been categorized and how they impact their financial responsibility. The patients can also understand if they are getting the full benefits or discounts offered by the insurance plan.
These benefit statements also provide useful details such as the personal account information, like the patient’s name, treatment dates, and claim numbers.
Charges that the insurance company agrees to pay as per the policy plan. The patient can also understand other charges such as copayments, deductibles, etc. Details for claim denials, such as non-covered benefits, can also be included.
While COB vs EOB are terms that go hand in hand, the team needs to identify key differences between them. The patient gets the EOB provided by the insurance company once the dental team completes the claim submission. The EOB is a useful document, as it helps in obtaining a COB.
The COB denotes the process of defining which insurance companies will be covering what portion of financial responsibility based on the insurance plans of the patient. This is a requirement when patients are covered by the employer’s dental insurance plan as well as their spouse’s insurance plan.
The EOB, on the other hand, outlines how the patient’s insurance plans cover the cost of the treatment recommended by the practice.
The dental team needs to have a complete understanding of both of these processes. This helps to maximize the efficiency of the team for handling claim submissions and the revenue of the practice.
The dental team can use the EOB to understand if the insurance company rejects the claim submitted by the practice. The team can then refer to the COB data and use it to make the insurance company reconsider the rejected claim.
One should also note that most insurance organizations ask their partners to annually update COB information.
Dental healthcare spending is growing, and administrative expenses continue to rise. The dental team needs to have expertise in billing and collections. This not only enables claims submitted to get cleared, but it also helps the practice to maintain positive cash flows.
Quality treatment is not adequate, and the dental practice must ensure that it is operationally sustainable.
The team needs to be updated on terms and processes that include COBs and EOBs. This helps the team to know how to bill and code accurately while also maintaining patient goodwill.
