How does Sidecar Health handle Coordination of Benefits (COB)?
What is Coordination of Benefits (COB)?
If you have Sidecar Health and another health insurance plan, COB helps ensure you get the most out of both plans. One of your plans will be designated as the primary plan, and the other will be the secondary plan. The primary plan pays for your covered medical expenses first, up to their benefit limits. After the primary plan pays its share, COB ensures your secondary plan steps in and contributes to the remaining costs.
As a Sidecar Health member utilizing COB, your plan will work differently. Find helpful information below on how to initiate the process and how your plan will work when using COB for non-prescription medical care.
How to initiate Coordination of Benefits with Sidecar Health:
- Complete COB form
- Note: Completing the form as soon as possible helps us expedite the process so you’re set up by the time you start using your coverage.
- Be on the lookout for your Coordination of Benefits card: Once we confirm your other health insurance plan coordinates benefits with Sidecar Health, you'll receive a card in the mail to present with your other insurance card for non-prescription medical care.
Using COB for medical care:
- Do not pay: Ask the provider to bill Sidecar Health directly. Don't use the Sidecar Health VISA benefit card to pay.
- Share both insurance cards: Show both your Sidecar Health COB card and your other insurance ID to the provider for clear billing and claims instructions.
- If you haven't received the COB card in the mail yet, show your Sidecar Health digital member ID card, found in the member portal.
- If you have Medicaid or Medicare, share their ID card as well.
- What happens next (claim processing):
- Sidecar Health processes the claim and pays the provider directly.
- If there's a remaining balance, the provider sends it to your secondary insurance.
- You'll receive a final bill if both insurances haven't covered everything. Pay this with your own payment method, not the Sidecar Health VISA benefit card.
IMPORTANT: COB does not apply to prescriptions. Pharmacies cannot bill Sidecar Health directly. Follow the standard Sidecar Health payment process for prescriptions:
- Pay at the pharmacy with the Sidecar Health VISA benefit card or your preferred method.
- Provide discount codes (optional) from programs like ScriptSave or GoodRx to the pharmacist before paying. This can further reduce your cost.
- Upload your itemized bill to the Sidecar Health member portal for claim processing. You have 90 days to complete this step.
- If you have a prescription drug deductible, download an Explanation of Benefits (EoB) after processing. Submit it to your secondary insurance for potential reimbursement.
For more information on how your plan works at the pharmacy, visit sidecarhealth.com/rx.
Additional COB FAQs:
What do I do if my provider has questions on Coordination of Benefits?
- Direct them to sidecarhealth.com/providers. Provider resources specific to COB are available at sidecarhealth.com/providers/claims/.
- Billing instructions are on the back of your COB card and digital member ID card.
- Our Member Care and Provider Relations teams can call the provider directly if needed.
Is this COB process applicable to any type of other health insurance, or just for those with Medicare and Medicaid?
Yes, this process applies to all types of other health insurance.
What happens if my other insurer requires prior authorization, but Sidecar Health does not?
The primary insurer's preauthorization requirements are followed.
What happens if I pay for medical care at the time of services using the Sidecar Health VISA benefit card (instead of presenting both cards to the provider and having them bill Sidecar Health)?
- If the service doesn't apply to your deductible, COB might not be needed.
- We'll process the expense normally in this case.
- If the Sidecar Health VISA paid for a service your secondary insurance should have covered, we'll contact the provider to explain, request a refund, and have them bill us for proper processing.