When coverage is available from more than one source, providers often feel a false sense of security that at least one source will pay. In these situations, payers aware of potential other coverage race to pay secondary, i.e., lower benefits. It is not uncommon for multiple payers to claim responsibility for secondary payment, while none makes primary payment. Despite multiple payers with some form of responsibility, provider and patients often experience COB denials from both!
TGF utilizes applicable state and federal laws regarding COB, as well as commercial contract language that controls these disputes. We work with all relevant payers to ensure proper primary and secondary (and sometimes, tertiary) payment with full reimbursement and coverage for providers and patients.
- When multiple sources of coverage exist, it is not uncommon for payers to dispute primary liability—resulting in denials from all payers
- TGF will consult with all payers and develop a solution after considering the payers’ COB provisions and applicable laws