Dental claims become significantly more complex when a patient has more than one insurance plan. While dual coverage can increase benefits for patients, it often leads to payment delays, partial reimbursements, or denials if Coordination of Benefits (COB) is not handled correctly.
Understanding how coordination of benefits works is essential for dental offices to submit accurate claims, avoid rework, and maintain steady cash flow.
What Is Coordination of Benefits in Dental Billing?
Coordination of Benefits refers to the process insurance companies use to determine which plan pays first when a patient has multiple dental insurance policies. One plan is designated as the primary payer, while the other becomes the secondary payer.
The primary insurance processes the claim first. After payment is made, the remaining balance may be sent to the secondary insurance for further reimbursement, depending on the plan’s rules.
If COB is not established correctly, claims can stall before payment is released.
How Primary and Secondary Insurance Are Determined
Insurance carriers follow specific rules to decide payment order. Common factors include:
Whether the patient is the subscriber or a dependent
The birthday rule for dependents
Employer versus spouse coverage
Active versus inactive policies
When this information is missing or incorrect, insurers may reject claims until COB details are clarified.
Common COB Errors That Delay Dental Claim Payments
Coordination of benefits issues are a frequent cause of delayed reimbursements. Some common problems include:
Incorrect primary insurance listed
Missing secondary insurance information
Incomplete subscriber or employer details
Failure to submit the primary EOB to the secondary payer
These errors often result in claims being placed on hold or returned for correction, increasing A/R days and staff workload.
Why Claims Get Denied Without Proper COB Setup
Even when a claim is coded correctly and services are covered, insurers may deny payment if COB is unresolved. Carriers need confirmation that the claim has been processed by the correct payer first.
Without this confirmation, secondary insurers may deny the claim outright, leaving the balance unpaid and requiring follow-up or resubmission.
The Impact of COB Issues on Patient Balances
When insurance payments are delayed due to COB errors, patient statements may show balances that are not final. This can lead to confusion, billing disputes, and frustration for patients who expect their insurance to cover a portion of the cost.
Clear coordination of benefits helps dental offices provide accurate estimates and maintain patient trust.
How Dental Offices Can Manage COB More Effectively
Proper coordination starts before treatment. Dental practices should:
Verify all active insurance plans during eligibility checks
Confirm which policy is primary and which is secondary
Collect accurate subscriber and employer information
Submit primary EOBs with secondary claims promptly
Consistent verification reduces delays and improves payment turnaround times.
The Role of Professional Dental Billing Support
Managing coordination of benefits can be time-consuming, especially for busy dental offices. Experienced dental billing teams handle COB setup, monitor claim status, and ensure claims move smoothly between payers.
With professional support, practices experience fewer denials, faster reimbursements, and more predictable revenue.
Coordination of benefits plays a critical role in determining how and when dental claims are paid. When COB is overlooked or handled incorrectly, even valid claims can be delayed or denied.
By verifying insurance details early and maintaining accurate billing workflows, dental offices can reduce payment disruptions, improve patient satisfaction, and protect cash flow. Partnering with a knowledgeable dental billing team further ensures that claims involving multiple insurance plans are processed efficiently and correctly.
