In the context of coordination of benefits for a married patient with two employer-based plans, which plan is typically billed first for the patient’s care?

In the context of coordination of benefits for a married patient with two employer-based plans, which plan is typically billed first for the patient’s care?

• A. The Wife's Insurance
• B. The Husband's Insurance
• C. The Plan with Earlier Birthday
• D. The Plan with Lower Deductible

Answer: (A)

In coordination of benefits, you determine which insurer pays first by looking at which plan has primary responsibility for the patient. When a married patient has two employer-based plans, the primary payer is typically the plan of the policyholder who covers the patient as a dependent. In many cases, that means the spouse’s plan serves as primary for the patient, so the wife’s insurance would be billed first. After that, the other plan acts as secondary to cover remaining costs, if applicable. The birthday rule applies mainly to dependent children, not to adults, and deductible amounts don’t determine payer order. Always confirm with the specific plans’ COB rules, but the common approach supports billing the wife’s plan first in this scenario.

In coordination of benefits, you determine which insurer pays first by looking at which plan has primary responsibility for the patient. When a married patient has two employer-based plans, the primary payer is typically the plan of the policyholder who covers the patient as a dependent. In many cases, that means the spouse’s plan serves as primary for the patient, so the wife’s insurance would be billed first. After that, the other plan acts as secondary to cover remaining costs, if applicable. The birthday rule applies mainly to dependent children, not to adults, and deductible amounts don’t determine payer order. Always confirm with the specific plans’ COB rules, but the common approach supports billing the wife’s plan first in this scenario.