Coordination of Benefits (COB) is the process insurance companies use to determine how to cover your medical expenses when you have more than one active health insurance plan. COB tells insurers which plan pays first (primary) and which plan pays second (secondary). This helps prevent delays, duplicate payments, or billing errors.
Primary vs Secondary Insurance
Some people have more than one health insurance policy. If you have two plans:
- Your primary insurance pays the claim first.
- Your secondary insurance may pay part or all of the remaining balance.
Example:
You might have Aetna through your employer and UnitedHealthcare through your spouse. Aetna may be primary, and United may be secondary.
| Note: If you’re not sure which plan is primary, contact your insurance company. |
Frequently Asked Questions (FAQs)
Does Alma accept secondary insurance?
No. Alma does not accept secondary insurance. Because of this:
- Only submit your primary active insurance to Alma.
- If you enter secondary insurance, your insurance company will deny your claim
- You will owe out-of-pocket costs for each session unless you provide an eligible primary plan that Alma accepts.
| Note: Primary and secondary insurance policies are not interchangeable. The insurance company decides which policy is primary and does not allow individuals to change it. |
If Aetna is your primary plan and UnitedHealthcare is your secondary plan, but your Alma provider only works with United, you cannot choose United as your primary plan.
Alma cannot submit claims to your primary to be denied first and then submit to your secondary. The secondary insurance will only process claims after the primary insurer processes them. The insurance companies, not Alma, set these policies
How insurers decide which plan is primary
Insurance companies follow the standard guidelines below:
| Situation | Primary | Secondary |
| You’re under 26 and covered by your school/employer plan and your parent’s plan | School- or employer plan | Parents’ plan |
| You’re married and each partner has coverage through their employer. | Your employer’s plan | Your spouse’s employer plan |
| You’re under 26 with married parents and both parents cover you under their separate plans. | The parent whose birthday is first in the calendar year. This is known as the birthday rule | The parent whose birthday comes second in a calendar year |
| You’re under 26 with divorced parents and both parents cover you under their separate plan. | Parent with custody (or birthday rule if joint custody) | The parent who doesn’t have custody, if applicable, or the parent whose birthday comes second in a calendar year |
| If you are retired or covered by Medicare/Medicaid | Medicare is ALWAYS primary | You or your spouse's previous employment insurance or any insurance plan you have opted to cover what Medicare does not. |
What happens if there’s a COB issue?
If your insurance company flags a COB issue, Alma will contact you, and you will need to call your insurance company to confirm which plan is primary. To do this, follow the steps below:
What to have when you call your insurance
- Your date of birth
- Member ID for primary plan
- Appointment dates (MM/DD–MM/DD)
- Name and member ID of secondary insurance (if applicable)
How to resolve COB (step-by-step)
- Call the number on the back of your insurance card and follow the prompts on the automated system.
- When prompted, say “Claims.” This will get you to the claims department.
- Choose Mental Health or Behavioral Health for the category of claim.
- Once you reach a representative, say:
“I’m calling to verify my Coordination of Benefits for my claim(s) on [date]. This policy is my primary insurance.” - Answer any follow-up questions.
- Once you update your Coordination of Benefits and the insurer removes the hold, ask them to confirm that they will reprocess all claims
- Request a call reference number and share this reference number with us after your call.
What Alma does next
One week after we contact you, Alma will follow up with your insurance to confirm:
- Whether the plan you shared is primary, and the insurance company incorrectly denied the claim(s)
or
- Whether the plan is secondary and the insurer correctly denied it.
What happens if Alma confirms your plan is primary?
No action is needed on your end. Alma will reprocess all affected claims.
What happens if Alma confirms your plan is secondary?
Because Alma does not accept secondary insurance, you can still continue care with your provider; however, you will need to pay for your sessions directly instead of using insurance. You and your provider must agree on an out-of-pocket rate.
Note: While your insurer reviews your COB, you may receive an Explanation of Benefits (EOB) that shows a denial. Your benefits in the Alma portal will stay active during this time. Alma will update you and your provider with the next steps once the insurer resolves the issue.
How to prevent COB issues
- Make sure the insurance you submit to Alma is your primary active plan.
- If you fall into any of the situations listed in the table above, contact your insurer to confirm which plan is primary.
- Update your insurance details in the Alma portal at any time if your primary plan changes.