Learn How to Coordinate Blue KC Benefits with Other Health Insurance.
What is Coordination of Benefits?
Coordination of Benefits (COB) establishes the order of payment when two or more medical plans (primary and secondary) cover an individual and makes sure that no insured person receives more than 100 percent of the allowable expenses for an insured service. The primary plan pays benefits as it would without the presence of a secondary plan. A secondary plan reduces its benefits so that the total benefits provided by both it and the primary plan are not more than the total allowable expenses.
Why does Blue Cross and Blue Shield of Kansas City (Blue KC) need to know about other health/dental coverage that I have?
Many people are insured under more than one health and/or dental insurance plan at the same time. Because of dual insurance, Medicare Secondary Plans (MSP) and Coordination of Benefit (COB) requirements, Blue KC needs to determine primary insurance based on the facts of each situation. Most health insurance and dental plans include a COB provision that defines these requirements. This provision prevents payments from all Plans from exceeding the total allowable expense.
Will my claim be delayed because of COB?
Blue KC is committed to processing your claims in a timely manner. However, if a claim is received and updated COB information is needed, the claims for that member will be delayed until Blue KC receives the requested information. After Blue KC receives the requested information and the COB information is updated with the appropriate information, Blue KC will process your claims. If you receive a COB letter requesting information about Medicare or other insurance, please respond as soon as possible.
Please note, Blue KC will send letters to you requesting the required information that may be missing in our COB file. Please follow the instructions given in the letter to respond by mail, phone or through our website. We update our files annually, so you will receive a request for updated COB information every 12 months.
How can I avoid the delay in the processing of COB claims?
To avoid a delay in the processing of COB claims, please follow these steps:
- When your providers submit claims to Blue KC, make sure that they have the most current information on your family and other insurance. This will assist your provider in filing the claim first with the primary plan and then with the secondary plan.
- Make sure that Blue KC has current information on your family regarding other health insurance.
- Follow the instructions given in the letters that Blue KC mails to you requesting updated health information and whether to provide that information to us by mail, phone or through our website.
How does Blue KC determine whether they should pay my claim before or after my other plan pays?
For a detailed explanation of COB and order of benefit determination rules, please review your Blue KC certificate. If you need a current copy, please call the Customer Service number listed on your Blue KC member ID card.
Who is included in COB?
Yourself, if you are insured under two or more group health insurance plans or Medicare; your spouse, if your spouse has health and/or dental insurance coverage through his or her employer or Medicare and also has coverage under your health insurance plan; and your dependent children, if they are insured under two or more health insurance plans or Medicare.
Why does Blue KC need a copy of my divorce decree?
We want to make sure that we have the order of benefits determination identified correctly so that we can process claims accurately. Please refer to your Blue KC health benefits certificate for detailed information.
Why does Blue KC need a copy of my Medicare card?
Sometimes it’s unclear as to whether or not a member has both parts A & B of Medicare. Or, the effective date of Medicare benefits is unclear. When Blue KC receives a copy of your Medicare card, it helps us input the Medicare information accurately and helps us process claims in a timely manner. Other information that helps with COB determinations include the age of the insured and reason for Medicare insurance (e.g., Disability, End Stage Renal Disease, etc.).