What Is Coordination of Dental Benefits?

Coordination of Dental Benefits (COB) plays a key role in handling claims when a patient is covered by more than one dental insurance plan. For dental teams, understanding how COB works can help avoid claim denials, reduce billing confusion, and keep your revenue cycle running smoothly.

COB prevents overpayment by outlining how multiple insurance plans split financial responsibility. One plan is designated as primary, processing claims and paying first. The secondary plan then reviews any remaining balance, applying its own rules to determine what, if anything, it will pay.

Consider a $1,000 root canal: if the primary plan covers 80% ($800), the patient is left with a $200 balance. Depending on its COB method, the secondary plan may cover some or all of that remaining amount.

Knowing these details helps your team set accurate expectations and avoid billing surprises for patients with dual coverage.

Types of Coordination of Dental Benefits

COB methods vary widely by insurer, and they significantly influence how much coverage a patient receives:

Traditional COB: The secondary plan contributes to the remaining balance, allowing combined payments to reach 100% of the treatment cost. This is typically the most favorable approach for patients.

Non-duplication of benefits: The secondary plan compares its allowance to what the primary already paid. No additional payment is made if the primary’s payment matches or exceeds the secondary’s.

Maintenance of benefits: The secondary calculates its benefit as the only plan, then subtracts the primary’s payment, often leaving the patient with some balance.

Carve-out: The secondary reduces its benefit by the amount already paid by the primary, usually leading to lower total coverage.

Each method can lead to very different out-of-pocket costs for the patient and may require tailored billing follow-ups by your team.

Distinguishing Between Primary and Secondary Plans

Knowing which dental insurance plan is primary and which is secondary affects everything from how claims are processed to how much patients pay at the dentist.

Primary coverage pays first and handles most of the patient's dental treatment costs. It processes claims first and typically covers preventative care like cleanings, X-rays, and more complex procedures, depending on your specific plan.

Secondary coverage kicks in after the patient's primary insurance. It helps with remaining costs not fully covered by the primary plan, reducing what the patient has to pay out-of-pocket.

Rules for Determining Primary Coverage

Several established rules help sort out which plan comes first when you have dual coverage:

For adults:

• The patient's employer's plan is typically primary

• If a patient and their spouse both have coverage through work, their employer's plans are primary for them

• If a patient has insurance from two jobs, the plan they had longer becomes the primary one

For active vs. inactive coverage:

• Active employee coverage beats COBRA or retiree coverage

• If a patient has both an active employer plan and coverage as a dependent on another active plan, their employer plan comes first

For dependent children:

• The "birthday rule" usually applies: the parent whose birthday falls earlier in the calendar year (month and day only) provides primary coverage

• In divorce or separation cases, court orders determine which parent's plan is primary

• Without a court order, the custodial parent's plan generally comes first

While the Affordable Care Act lets young adults stay on their parents' health plans until 26, this doesn't extend to a dependent's child. If a patient is on their parents' plan and has a child, that child can't be added to the grandparents' policy.

Methods Used in Coordination of Dental Benefits

The way insurance plans coordinate benefits directly impacts what your patients owe, and what your practice collects. Understanding the different methods used in Coordination of Benefits (COB) helps your team manage expectations, avoid billing surprises, and improve claims accuracy.

Here’s a breakdown of the most common COB methods, how they work in practice, and what they mean for your bottom line.

Traditional Coordination of Benefits

This is the most patient-friendly approach and the one you hope to see when dual coverage is in play. Under traditional COB:

• The primary plan pays first according to its standard coverage.

• The secondary plan evaluates the remaining balance and may pay part or all.

• Together, both plans can cover up to 100% of the allowed amount.

In practice: If a patient has a $1,000 procedure and the primary plan pays $700, the secondary plan reviews the $300 balance. If it allows the full amount, it may cover the entire remainder, leaving the patient with no out-of-pocket cost.

This method helps patients maximize their benefits and allows your practice to collect more of the treatment cost without chasing balances.

Maintenance of Benefits (MOB)

MOB is less generous and more common in employer-sponsored plans. Here's how it works:

• The secondary plan subtracts the amount paid by the primary from its own allowable amount.

• Deductibles and coinsurance are applied to the reduced figure, not the original treatment cost.

For example: On a $1,000 treatment, if the primary covers $700, the secondary recalculates based on the remaining $300. If it covers 80%, the patient still owes $60 out-of-pocket.

This method often surprises patients with balances they assumed would be covered. To avoid misunderstandings, it’s important to flag MOB policies during insurance verification.

Carve-Out Method

Carve-out plans use a similar logic to MOB but with a different calculation model:

• The secondary plan determines what it would have paid if it were the primary.

• It subtracts the amount already paid by the actual primary plan.

• It pays the difference, if any.

In action: If the secondary had paid $800 on a $1,000 procedure and the primary had already paid $700, the secondary would have paid the $100 difference.

Carve-out methods don’t always leave patients with large balances, but they require clear communication, especially when plans have vastly different fee schedules.

Non-Duplication of Benefits

This is the most restrictive method and is frequently used in self-funded employer plans:

• If the primary plan paid the same or more than the secondary would have, the secondary pays nothing.

• If the primary paid less, the secondary may contribute, but only up to the difference.

Example: If a crown costs $1,000, the primary pays $500, and the secondary would have paid $450 as primary, the secondary pays nothing, because the primary’s payment exceeds what the secondary would’ve covered.

This often catches patients off guard and can affect treatment acceptance if not discussed upfront. Always verify this COB type before presenting a treatment plan.

Why This Matters to Your Practice

Knowing how COB works across different carriers allows you to set realistic expectations for patients and reduce the risk of unpaid balances. It also helps your front desk team verify coverage and prepare accurate treatment estimates.

COB rules aren’t standardized, so always confirm the method used by each insurance company before treatment begins. Clear documentation, detailed benefit breakdowns, and proactive communication can make all the difference in managing dual insurance cases smoothly.

4 Steps to Navigate Coordination of Dental Benefits

1. Understand Your Patient's Policy Provisions

Managing coordination of benefits (COB) starts with thoroughly understanding your patient’s insurance policies. Before treatment begins, review the COB sections of each plan to identify which is primary, what restrictions apply, and any documentation requirements. Some plans prohibit overlapping coverage, making this step necessary for accurate billing.

When coverage gaps or limitations arise, offering in-house dental plans can give patients an alternative and help maintain continuity of care.

2. Be Informed About Active Plans

Once you’ve reviewed the policies, make sure your team is aware of all active insurance plans. This clarity helps with claim sequencing, reduces rejections, and allows staff to support patients better.

Take, for example, a 24-year-old patient who might still be covered under both parents’ plans, their own employer's plan, and a spouse’s plan. Without complete information, COB issues can quickly derail treatment planning and reimbursement. A proactive approach helps your team and your patients confidently navigate multiple coverages.

3. Follow the Sequential Claims Process

Coordination of benefits only works when claims are submitted in the correct order. Start by billing the primary insurance and wait for the Explanation of Benefits (EOB). Once the primary has processed the claim, submit the EOB, along with any required documentation, o the secondary insurance. Some carriers may also request additional forms before processing their portion.

Establishing the right order from the start helps avoid rejections, delays, and unnecessary resubmissions. A well-trained front office team can make this process routine, keeping claims on track and revenue flowing smoothly.

4. Maintain Thorough Documentation

Strong documentation practices are necessary for navigating COB. Keep copies of all EOBs, log every claim submission and payment, and document any communication with insurance providers. Compare reimbursements against policy terms to catch discrepancies early, and follow up promptly with insurers if something doesn’t add up.

Always bill the full procedure fee to each insurance plan, and avoid applying write-offs until all claims have been finalized. This approach guarantees accurate accounting and maximizes reimbursement.

Structured tools like SOAP notes can improve documentation and clarity, especially when dealing with complex or overlapping coverage. The more precise your records, the easier it becomes to support claims, resolve issues, and protect your practice from revenue loss.

How to Implement Coordination in Dental Offices

For dental practices specifically:

• Train front office staff to verify all potential coverage during intake

• Develop a system for tracking primary, secondary, and additional coverage, improving dental office efficiency strategies

• Create clear procedures for submitting sequential claims, incorporating standard operating procedures

• Establish a process for monitoring payment status across multiple insurers, potentially using AI in dental practice management

• Consider working with experienced dental billing companies for complex cases or explore automating administrative tasks

These steps will help you navigate the coordination of dental benefits maze, allowing for maximum coverage while staying compliant with all policy requirements.

Potential Challenges and Solutions

Challenges can still arise even with a strong understanding of coordination methods and organized systems. These issues, from payment delays to coverage denials, can disrupt workflows and impact patient satisfaction, but they’re manageable with the right approach.

Delayed Payments

Late claim submissions often cause reimbursement delays. Most PPO plans require claims to be filed within a year of the service date, but some insurers have shorter windows. Cigna, for instance, requires claims from participating providers within 90 days and out-of-network claims within 180 days.

To stay ahead, maintain a calendar of service dates and submission deadlines. A consistent claim review and follow-up process can help catch issues early and avoid unnecessary delays.

Coverage Denials

Claims are frequently denied due to incorrect patient information, missing documentation, uncovered services, or lack of pre-authorization. These denials are often preventable with accurate data entry and thorough verification before treatment.

If a claim is denied, patients should be encouraged to appeal. Many denials are overturned with complete documentation and a clear explanation of medical necessity. Supporting patients through the appeal process helps recover revenue and reinforces trust.

Dual Coverage and Out-of-Pocket Costs

Dual coverage can reduce costs, but it also introduces complexity. Differences in how plans coordinate benefits, overlapping deductibles, and unclear payment responsibilities often lead to patient confusion and billing issues.

Review both plans before treatment to reduce surprises, confirm the order of benefits, and identify any coordination restrictions such as carve-outs or non-duplication clauses. When possible, recommend in-network providers for both plans, and advise patients to keep organized records of their EOBs and payments.

Improve Practice Efficacy Through Smarter Insurance Handling

Mastering the coordination of dental benefits is a powerful way to organize operations, improve collections, and deliver a better patient experience. Understanding how primary and secondary plans interact and verifying policies upfront helps your team minimize delays and keep the revenue cycle moving.

Strong documentation and clear communication with insurers are requisites, especially when dealing with dual coverage or complex COB scenarios. Staying proactive and organized allows your practice to resolve issues quickly and keep patients informed every step of the way.

Looking to improve office functionality beyond insurance? Teero helps dental offices stay fully staffed without the stress of last-minute hiring. Our platform connects you with personally vetted hygienists, making filling shifts easy and maintaining consistent care, even when short-handed.