In a COB arrangement, which statement correctly describes the order of payment and how the patient balance is determined?

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Multiple Choice

In a COB arrangement, which statement correctly describes the order of payment and how the patient balance is determined?

Coordination of Benefits means there are multiple insurance plans, so one is designated the payer first (primary) and another pays remaining eligible costs (secondary). The primary plan processes the claim and pays according to its contract, applying any deductible, coinsurance, or copayments. After that payment, the secondary plan is billed for whatever eligible charges remain and pays according to its own benefits. The patient’s balance is then determined from what’s left after these payments, taking into account any deductible not yet met, plus any coinsurance and copays required by the plans. If both payers cover the charges within their limits, the patient may owe little or nothing. If there are gaps, the patient bears the remaining amount.

Coordination of Benefits means there are multiple insurance plans, so one is designated the payer first (primary) and another pays remaining eligible costs (secondary). The primary plan processes the claim and pays according to its contract, applying any deductible, coinsurance, or copayments. After that payment, the secondary plan is billed for whatever eligible charges remain and pays according to its own benefits. The patient’s balance is then determined from what’s left after these payments, taking into account any deductible not yet met, plus any coinsurance and copays required by the plans. If both payers cover the charges within their limits, the patient may owe little or nothing. If there are gaps, the patient bears the remaining amount.

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