Explanation of Benefits (EOB) - The EOB is a statement from your insurance company that explains your benefits for a particular date of service. It includes: The services provided, by which Dr. or Facility, the amount billed, the amount your insurance allowed, the amount that insurance paid (if any) and the amount that you may be billed for (if any.)
The Birthday Rule - This is when both spouses or parents have health insurance that covers their child(ren). The birthday rule helps insurance companies coordinate benefits. Under this rule, the plan of the parent whose birthday occurs first in the calendar year is designated as primary. The date of birth is the determining factor, not the year. So it does not matter which spouse is older. It starts by month so if Dad was born in January and Mom was born in September- Dad’s insurance would be primary. In the case that both parents were born in the same month, it would then go by date. There are exceptions to the rule: If both parents share the same birthday, the parent who has been covered by his or her plan longest provides the primary coverage for the children. If one spouse is currently employed and has health insurance through a current employer, and the other spouse has coverage through a former employer (e.g., through COBRA), the plan belonging to the currently employed spouse would be primary. In the event of divorce or separation, the plan of the parent with custody generally provides primary coverage. If the custodial parent remarries, the new spouse's coverage becomes secondary. Read your policy carefully to make sure you understand how your insurance company handles dual coverage. Court orders may take precedence over the birthday rule and exceptions. Please provide the office with this documentation.
