#1 Reason for Denied Claims: No Current Coordination of Benefits Form

Published July 9, 2021

You must submit an updated Coordination of Benefits form any time you or your dependents have coverage with another health plan and at least once every 12 months during which you are covered under the Health Plan, even if your information has not changed.

Every year you are eligible for benefits under the DGA–Producer Health Plan, you receive an open enrollment packet with information about your coverage, as well as documents the Health Plan needs to accurately process claims for you and your dependents. One of those documents is called the Coordination of Benefits Form, which is used by the Health Plan to determine if you have health coverage with other insurers so that your claims are processed appropriately.

The Health Plan requires that you update your Coordination of Benefits information any time you or your dependents add or drop coverage with another health plan and at least once every 12 months during which you have Health Plan coverage, even if the information has not changed. Without a current Coordination of Benefits Form, your claims will be denied.

The number one reason claims are denied is because there is no current Coordination of Benefits Form on file. Though claims denied for this reason can be reprocessed once you submit an updated Coordination of Benefits Form, it is easier to avoid the hassle if you can. Returning your Coordination of Benefits Form as soon as possible after you receive your open enrollment packet will help you avoid your and your dependents’ claims being denied. For more information about coordination of benefits, refer to our Coordination of Benefits FAQs at www.dgaplans.org/COB. You can download a copy of the Coordination of Benefits Form at www.dgaplans.org, or you can call the Health Plan at (323) 866-2200, Ext. 401, to request a copy be mailed to you at no cost.