Coordination of Benefits in Pediatric Billing: 3 Simple Ways to Avoid Denials
Let’s talk about something no one really enjoys—but every pediatric practice deals with: Coordination of Benefits, or COB.
It’s not exciting. It’s not even particularly interesting. But it is essential. And if your practice doesn’t have a solid process for COB, you’re almost guaranteed to see delays in payments and frustrated families.
The good news? A few small process improvements—and a little empathy—can make a big difference.
What Is Coordination of Benefits (COB)?
COB is the insurance company’s way of figuring out who pays first when a patient is covered by more than one plan. Sounds simple, right?
Not really. Unfortunately, COB often creates confusion for both your office and your patients.
Almost every pediatric patient will encounter COB at some point, especially if their family has recently changed jobs, added a new child to the plan, or has multiple insurance carriers in the household. That’s why having a consistent, thoughtful approach to managing COB is key.
The Patient Experience: Why COB Is So Frustrating
Here’s how it often plays out:
- A patient comes in for a visit.
- Weeks later, their insurance sends a vague letter: “Please contact us regarding coordination of benefits.”
- That letter goes into a drawer—or worse, the recycling bin.
- A few weeks after that, your office calls or emails the family: “Please complete your COB.”
- Then a bill arrives saying the claim was denied, and the family suddenly owes $150 for a well visit they thought was covered.
Most of the time, families aren’t ignoring you on purpose. They’re confused. They don’t know what COB is or why they need to deal with it again. They may have already done it last year and forgotten. Or they might think it’s something you, the provider, can handle.
That’s where your office’s tone and process make all the difference.
3 Ways to Make COB Easier for Everyone
1. Educate Patients Up Front
Be proactive. If you let families know ahead of time what COB is—and why they might hear from their insurance—you can help prevent confusion later.
Some easy ways to educate:
- A simple handout at check-in
- A laminated sign in the exam room
- A short message sent through your patient portal
Keep it short and sweet. Try language like:
“You may receive a letter or call from your insurance asking whether your child has another plan. This is called ‘Coordination of Benefits.’ Just call them back to confirm your child’s coverage, and that’s it!”
When patients know what’s coming, they’re much more likely to take action.
2. Don’t Immediately Bill the Patient
If a COB denial comes through, pause before moving the balance to the family.
Instead, reach out with a clear, helpful explanation:
“Your insurance company needs a quick confirmation from you before they can process this claim. We can’t do it on your behalf, but once you call them, let us know who you spoke to and the reference number. We’ll take it from there.”
This positions your team as a partner—not just another bill collector.
3. Don’t Give Up
Even if a COB issue has dragged on for months (or years), it’s not too late to resolve it.
Call again. Send another note. Explain—again—that they may not owe the balance. All they need to do is make a short phone call to their insurance provider.
We’ve seen claims get paid two or three years after the denial, simply because the patient finally called to confirm they didn’t have secondary insurance at the time of service.
Persistence pays off.
Keep It Simple. Keep It Human.
COB doesn’t have to be a headache—for you or your patients. A little education, clear communication, and patience go a long way.
If your team takes a few extra steps to help families understand what’s happening, they’ll feel supported—and your claims will get paid faster.
Thanks for joining me for this Coffee Break. If you have questions you’d like me to cover next time, just reach out! I’d love to hear what’s on your mind.