Category: Insurance | Difficulty: Intermediate | Priority: Nice-to-know
Rules used to determine the order in which multiple plans pay when a member has more than one source of coverage, to avoid paying more than 100% of the allowed amount.
How two or more plans decide who pays first and how much each will pay so the total does not go over the bill.
[[primary plan; secondary plan; dual coverage]]
Important for patients with more than one plan (e.g., both spouses' plans or a child with dual coverage) | Common Misconception: Patients with two insurances often expect 100% coverage — COB prevents payment of more than the actual fee, so dual coverage usually does not result in zero out-of-pocket costs.
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