Which provision ensures that insureds' benefits from all insurers do not exceed 100 percent of allowable medical expenses?

Which provision ensures that insureds' benefits from all insurers do not exceed 100 percent of allowable medical expenses?

• A. Coordination of benefits
• B. Power of attorney
• C. Beneficiary designation
• D. Prior authorization

Answer: (A)

This question is about how multiple health insurance plans pay for the same medical bill. Coordination of benefits is the process that ensures total payments from all insurers don’t exceed the allowed amount for the services. When a patient has more than one coverage, the primary plan pays first up to its allowed amount. The secondary plan then pays any remaining eligible charges up to the total allowable expenses, and in some cases a tertiary plan could pay if applicable. This system prevents overpaying the claim and avoids duplicated payment for the same services. The other options don’t manage how multiple insurers share payment. A power of attorney allows someone to act on another’s legal or financial matters. Beneficiary designation names who receives benefits after death. Prior authorization is a pre-approval requirement before certain services. None of these coordinate payments across multiple insurers.

This question is about how multiple health insurance plans pay for the same medical bill. Coordination of benefits is the process that ensures total payments from all insurers don’t exceed the allowed amount for the services.

When a patient has more than one coverage, the primary plan pays first up to its allowed amount. The secondary plan then pays any remaining eligible charges up to the total allowable expenses, and in some cases a tertiary plan could pay if applicable. This system prevents overpaying the claim and avoids duplicated payment for the same services.

The other options don’t manage how multiple insurers share payment. A power of attorney allows someone to act on another’s legal or financial matters. Beneficiary designation names who receives benefits after death. Prior authorization is a pre-approval requirement before certain services. None of these coordinate payments across multiple insurers.