When does COB apply in a dental context?

Coordination of Benefits (COB) applies in a dental context primarily when a patient is covered under two insurance carriers. This situation arises when a patient has multiple insurance policies that may cover the same dental services. The purpose of COB is to determine the order in which the insurers will pay benefits, ensuring that the total reimbursement does not exceed the actual cost of care.

In this context, if a patient has two insurance plans—such as one through their employer and another through their spouse’s plan—COB rules dictate which plan will be considered the primary payer and which will serve as the secondary payer. This coordination helps avoid issues like overpayment and simplifies the reimbursement process for both the patient and the providers.

The other options refer to aspects of dental care that do not relate to the concept of coordinating benefits between insurance plans. Choosing a dental plan, changes in staff, or adjustments in a treatment plan are considerations relevant to patient care and administration but do not invoke the coordination of benefits process itself.