#1
What does COB stand for in the context of medical insurance coordination?
Coordination of Benefits
ExplanationCOB stands for Coordination of Benefits, which ensures proper payment when multiple insurance plans cover the same claim.
#2
In medical insurance coordination, what is 'balance billing'?
Billing for the remaining balance after insurance coverage
ExplanationBalance billing refers to charging the patient for the remaining balance of a medical bill after insurance has paid its portion.
#3
What is the purpose of a coordination of benefits (COB) provision in an insurance policy?
To determine the order in which multiple insurance policies will pay claims
ExplanationThe COB provision in an insurance policy establishes the sequence in which multiple insurance plans will pay for a claim to prevent overpayment.
#4
What is the 'birthday rule' used for in medical insurance coordination?
Resolving conflicts between insurers in cases of dependent coverage
ExplanationThe birthday rule is utilized to resolve conflicts between insurance companies when determining which policy covers a dependent child.
#5
What is a 'co-payment' in the context of medical insurance coordination?
A fixed amount paid by the insured for a covered healthcare service
ExplanationA co-payment is a predetermined, fixed amount that the insured individual pays for a covered healthcare service, typically at the time of service.
#6
In medical insurance, what is the primary purpose of coordination of benefits (COB)?
To avoid duplicate payments
ExplanationCOB is primarily aimed at preventing duplicate payments for the same medical expenses by coordinating coverage between multiple insurance plans.
#7
What is the 'birthday rule' in the context of medical insurance?
A rule to determine primary and secondary coverage for dependents
ExplanationThe birthday rule is used to determine which parent's insurance plan is considered primary for dependent children, based on the parent's birthdate.
#8
What is the role of the Explanation of Benefits (EOB) in medical insurance coordination?
To outline benefits covered by insurance
ExplanationEOB provides a detailed breakdown of the medical services rendered, the amount billed, the amount covered by insurance, and any patient responsibility.
#9
What is the difference between primary and secondary insurance in coordination of benefits?
Primary is the first insurance to be billed, while secondary covers deductibles
ExplanationPrimary insurance is billed first and covers the initial expenses, while secondary insurance covers any remaining costs, such as deductibles and copayments.
#10
Which federal law regulates the coordination of benefits (COB) for group health plans?
ERISA (Employee Retirement Income Security Act)
ExplanationERISA regulates coordination of benefits for group health plans, ensuring fair and consistent practices in the coordination of benefits.
#11
Which government program provides coordination of benefits for individuals with both Medicare and Medicaid?
Medicaid
ExplanationMedicaid provides coordination of benefits for individuals who are eligible for both Medicare and Medicaid.
#12
What is subrogation in the context of medical insurance coordination?
The process of recovering expenses from a third party responsible for an injury or illness
ExplanationSubrogation involves the insurance company seeking reimbursement from a third party responsible for causing the insured's injury or illness.
#13
What is a 'pre-existing condition' in the context of medical insurance coordination?
A condition that existed before obtaining insurance coverage
ExplanationA pre-existing condition refers to any illness or health condition that the insured had before obtaining insurance coverage.
#14
How does Medicare handle coordination of benefits for individuals with employer-sponsored insurance?
It depends on the size of the employer
ExplanationMedicare coordination of benefits with employer-sponsored insurance varies depending on the size of the employer and other factors.
#15
How does Medicaid handle coordination of benefits with other insurance coverage?
It depends on the state's rules and regulations
ExplanationMedicaid's approach to coordination of benefits with other insurance coverage varies based on state-specific regulations and policies.