Question

Which is a false statement of the COB?

A. COBs eliminate duplication of payments
B. It applies to a person who is covered under more than one health plan
C. COBs allow patients to receive the maximum benefits entitled to them
D. It coordinates payments for services up to 50 percent of the covered charges

Answer 1

The false statement about COB is "D. It coordinates payments for services up to 50 percent of the covered charges." COB ensures that the total payments do not exceed 100% of the covered charges by working out the payment responsibilities between multiple health insurance plans.

Step-by-step explanation:

Coordination of Benefits (COB) is a process used by insurance companies to determine the order of payment responsibilities when a person is covered by multiple health insurance policies. The false statement among the options provided is "D. It coordinates payments for services up to 50 percent of the covered charges." This statement is incorrect because COB typically coordinates payments so that the combined payment from all plans does not exceed 100% of the covered charges, not 50%.

COB ensures that the payment of claims is organized efficiently when a person is covered under more than one health insurance plan. It operates with the goals of eliminating duplication of payments (A), applying to individuals with multiple health coverage (B), and allowing patients to maximize benefits entitled to them (C). Essentially, COB prevents overinsurance and the potential for profiting from being insured twice.