COB Playbook

Calculating COB for a Patient

In our example, our patient’s name is Amy. In order to figure out whether a COB applies to Amy, we need to know her initial entitlement reason. Amy is under Age 65, not disabled, began dialysis on 12/18/2015. She had no training or transplant within the first 3 months of dialysis, but had a successful transplant back in 2003. Amy’s husband is the subscriber on an EGHP policy from Cigna and is working full time for a large employer group.

Successful transplant

ESRD Entitlement

RCDB / FDODE

 We conclude Amy’s initial Medicare entitlement reason is ESRD because she is under 65 and is not disabled.  Based on the ESRD entitlement reason, the subscriber must be currently working for the policy to coordinate ahead of Medicare. Since her husband is the employee and currently works for a large group, 30-month COB will apply.  Due to successful transplant in 2003, 3 month waiting period is waived.  If we count the 30 months, Medicare will become primary 6/1/2018.