How does Sidecar Health handle Coordination of Benefits (COB)?

What is Coordination of Benefits (COB)?

If you have both Sidecar Health and another health insurance plan, COB helps you get the most out of both. One plan will be designated as primary (pays first), and the other will be secondary. The primary plan pays for covered medical expenses first, up to their limits. Then, COB ensures your secondary plan contributes to 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 medical care and prescriptions.

How to initiate Coordination of Benefits with Sidecar Health:

1. Complete COB form  (<<< Click on “COB Form” for electronic form). Completing it early helps us set you up before using your coverage.
   • Need help determining which plan is primary vs. secondary? Give us a call.
2. Be on the lookout for your Coordination of Benefits card: Once we confirm your other plan coordinates benefits with Sidecar Health, you'll receive a card (for non-prescription medical care) to present with your other insurance card. You won't use this card for prescriptions.

Using COB for medical care

Important: Sidecar Health offers flexibility in choosing your provider, but it's important to be mindful of your other insurance plan's network to maximize coverage and avoid unexpected charges. If you choose to go to a provider who is out-of-network with your other insurance, we can still coordinate benefits with your other insurance. However, be aware that your other insurance may not pay anything towards the bill, potentially leaving you responsible for a larger portion of the cost.

At your appointment (regardless of which plan is primary):

• Don't pay or use your Sidecar Health VISA benefit card. Your provider will bill both insurance companies directly. We'll work behind the scenes to maximize your coverage.
• Show both insurance cards: Present your Sidecar Health COB card (or digital member ID card if you haven't received the COB card) and your other insurance ID. This ensures clear billing instructions.
• If you have Medicaid or Medicare, show their ID card as well.

Claim processing (depends on your insurance order):

Sidecar Health as primary insurance:

1. Provider bills Sidecar Health first.
2. Sidecar Health processes the claim and pays the provider directly.
3. If there's a remaining balance, the provider bills your secondary insurance.
4. You'll receive a final bill if both insurances haven't covered everything (pay with your own method, not the Sidecar Health VISA card).

Sidecar Health as secondary insurance:

1. Provider bills your primary insurance first.
2. Your primary insurer processes the claim and pays the provider directly.
3. If there's a remaining balance, the provider bills Sidecar Health.
   • Sidecar Health applies your benefits and may pay the provider additional funds (the amount paid by your primary affects this).
4. You may receive a final bill if there's still a balance after your insurance benefits are applied. Pay this bill with your own payment method, not the Sidecar Health VISA benefit card.

Filling prescriptions with Sidecar Health (primary vs. secondary):

Important: COB works differently with prescriptions. Pharmacies cannot bill Sidecar Health directly. Follow these steps for pharmacy interactions (they will vary depending on your insurance order):

Sidecar Health as primary insurance:

1. Pay at the pharmacy with the Sidecar Health VISA benefit card or your preferred payment method.
2. Provide discount codes (like ScriptSave or GoodRx) to the pharmacist before paying to lower your cost further.
3. Upload your itemized pharmacy bill to your expense in the Sidecar Health member portal within 90 days.
4. If you have a prescription drug deductible, download your Explanation of Benefits (EoB) after your claim is processed and submit it to your secondary insurance for potential reimbursement.

Visit sidecarhealth.com/rx for information on how your plan works at the pharmacy.

Sidecar Health as secondary insurance:

1. Check your primary plan's pharmacy network: Some plans may have preferred pharmacies for lower costs. See if there are any pharmacies in your network.
2. Show your primary insurance ID card at the pharmacy. The pharmacy will charge you your drug copay under your primary insurance.
3. Paying at the pharmacy:
   • Use your preferred payment method for any copays or coinsurance required by your primary plan.
   • If you prefer to use your Sidecar Health VISA benefit card, be sure to submit a copy of the pharmacy receipt to Sidecar Health for potential reimbursement. This way, we can see if any of your Sidecar Health benefits can be applied to further reduce your cost.

Additional COB FAQs:

What do I do if my provider has questions about 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.