Mastering Coordination of Benefits (COB) in Dental Billing: Avoiding Common Pitfalls
Insights from Michelle of Integrity Dental Billing, featured expert at Dental Insurance Live
Dental offices are increasingly encountering patients with dual insurance coverage. Whether it is a spouse’s plan, a secondary employer plan, or a combination of medical and dental coverage, the process of coordinating benefits between payers can be complex. Unfortunately, many practices either overlook COB entirely or mishandle it in ways that create payment gaps, rework, and patient confusion.
Michelle, founder of Integrity Dental Billing, is widely respected for her clear, methodical approach to dental revenue cycle management. In her session at Dental Insurance Live, she addressed the real-world COB scenarios that trip up even experienced billing professionals—and how to get it right every time.
What Is Coordination of Benefits?
Coordination of Benefits is the process of determining the correct order in which insurance carriers should be billed when a patient is covered under more than one plan. The “primary” plan pays first, followed by the “secondary” plan, which may cover some or all of the remaining balance.
Correct COB relies on multiple factors, including:
- The patient’s birthday (Birthday Rule)
- Group size and employment status
- Custodial parent status for dependent children
- Plan language around carve-outs, non-duplication clauses, and allowable charges
Common COB Mistakes and How to Avoid Them
Michelle identified several key COB missteps that result in claim denials or underpayment:
- Assuming the Patient Knows Which Plan Is Primary
Patients often believe their “better” plan is primary or default to the one they use more frequently. However, payer guidelines must determine this—not preference. - Submitting Claims to Both Carriers Simultaneously
Some offices send claims to both insurers at once to “save time.” This almost always results in rejections. The secondary payer needs an Explanation of Benefits (EOB) from the primary before processing. - Not Verifying COB Status During Intake
If COB is not identified and documented up front, practices can end up chasing down information for weeks post-treatment—while receivables remain uncollected. - Misreading EOB Language
Many billing teams mistake write-off indicators for denials or fail to apply secondary payments accurately due to overlapping code language or bundled charges.
Michelle emphasized that even a single error can lead to a cycle of rejections, delayed balances, and frustrated patients.
Best Practices for Managing COB
To prevent COB-related billing issues, Michelle recommends implementing the following protocols:
- Standardize Dual Coverage Intake Questions
Intake forms should ask specifically: “Do you or any dependents have additional dental insurance?” and capture policyholder relationships. - Create a Verification Checklist
Confirm which plan is primary using payer guidelines, not assumptions. Document the determination clearly in the patient’s chart. - Track and Attach EOBs Systematically
Use practice management software or cloud-based storage to save primary EOBs and automatically attach them to secondary claims. Manual upload should be the exception, not the rule. - Educate Front Desk and Billing Staff Together
COB is not just a billing department task. Front desk teams play a critical role in capturing accurate information at the time of scheduling and intake.
Addressing COB-Related Patient Communication
One area where Michelle sees practices struggle is in explaining COB-related balances to patients. Confusion often leads to distrust—especially when a patient receives a bill after thinking their coverage would “take care of it.”
Recommended communication strategies:
- Be transparent: Explain upfront how coordination works and that some plans may not cover 100 percent, even when secondary.
- Use real examples: Walk patients through their past claims to show where balances come from.
- Offer proactive estimates: Use verification details to generate COB-adjusted treatment estimates before the appointment.
“Clear expectations lead to faster collections and fewer upset patients,” Michelle noted. “When your team understands COB, it shows up in your case acceptance and patient trust.”
When COB Becomes a Compliance Concern
There are scenarios where mishandled COB can rise to the level of compliance risk—particularly if a practice:
- Submits inaccurate COB sequencing
- Fails to refund overpayments from dual payers
- Inappropriately uses write-offs to avoid adjusting for secondary coverage
Michelle’s approach at Integrity Dental Billing includes routine COB audits to catch any discrepancies and ensure refund compliance.
About the Expert
Michelle is the founder of Integrity Dental Billing and brings over 30 years of experience across both clinical and administrative roles in dentistry. Her firm provides full-service revenue cycle support, with a strong emphasis on transparent, personalized billing processes. She was a featured expert at Dental Insurance Live in July 2025, where she led an in-depth training on Coordination of Benefits and practical solutions for dual coverage complexities.