Skip to content
MarketScale
‹ Back to IndustriesHealthcare

Improving Coordination of Benefits

Healthcare providers are losing revenue to the same coordination of benefits problems that plagued the industry over a decade ago

This story was produced through MarketScale. See how Healthcare teams put it to work with Executive Thought Leadership.

By Acclara ·
Share

Key takeaways

01

Healthcare providers are losing revenue to the same coordination of benefits problems that plagued the industry over a decade ago

Get featured

Want to get featured in MarketScale Healthcare?

Create a free MarketScale workspace and get your company's expertise featured across our Healthcare coverage. No credit card, no demo required.

Request an invite

In this episode, Jeff Tanner from Acclara offers an insightful discussion about the persistent and perplexing issue of medical billing denials. Drawing from years of industry experience, he takes listeners on a journey, tracing the patterns and problems of "Coordination of Benefits" (COB) denials over more than a decade. The recurring challenges faced by healthcare providers, especially those in 2023, surprisingly echo those from 2010. Tanner sheds light on the complexities of the interactions between hospitals, insurance companies, and patients, outlining a system where communication breakdowns lead to substantial financial losses. This candid conversation delves into the intricacies of insurance denials, the convoluted processes hospitals go through, and the often bewildering experiences of patients caught in the middle. Whether you're in the healthcare industry or a patient trying to navigate the maze of insurance, this discussion offers valuable insights into the challenges and possible paths forward.

Video TranscriptExpand ↓

How are you working with providers right now around maybe even specifically like COB, then absolutely. So the denials are my passion because, you know, they're unavoidable. We're always gonna have them. We're we're not getting to that point. But if we do our jobs properly We have an opportunity to really be effective at challenging these payers because they're sitting around thinking about how to challenge you you need to be doing the same thing. And what's interesting, David, is when I go to a client today and I get in our system and I look at a denial report, the denial categories that I see today in twenty twenty three are the same ones I was seeing in twenty ten. Wow. The same high level grouping of denials. And, you know, some facilities try and dive deeper and say, okay. What does that one really mean? Because, you know, we have standardization in these claim adjustment reason codes, but then the remarks are different for every pair. So you can have five remarks from five different pairs mean the same thing. You've got to map to understand exactly what that payer's doing to you at every payer. And it's not a small task. No. But the dividends that could pay are worth the effort. And let me explain. So typically coordination and benefit denials, which is something I've only been seeing for the last five years, and it's getting worse. Hundreds of millions of dollars being lost at hospitals because we eventually give up. I end up in bad debt. So this is the most interesting concept to me. So a patient comes into the facility We provide services, we provide care, and we bill their insurance company. And the insurance company we have reason to believe that David might have some other insurance coverage. You need to you need to get with the patient and tell him to call us. Wait a minute. The patient pays their premium to you. I provided a service and you want me to call your customer to get them to call you. And then it just becomes a shell game. Yes. Yes. It is. We actually do this. We call the patient Generally three times, we send a couple of letters. And then the unfortunate problem is when we don't get the response, The hospital really has no choice but to flip it to self pay. Ultimately, we're responsible for our bill. Typically, when we do that, we get the angry call. And we're the ones that look like the evil one. Right? Because we've started charging you for something when you know you have insurance. We explain the situation. Your insurance company, you need to call them. They believe you have other coverage, can you call them and clear this up? So they call their insurance company. And then they insurance company says, oh, there's no problem on this side. It's the way they billed it. So we get another angry call, and we're saying, trust us. Alright. We're gonna call your insurance company call it. We call the insurance company. Patient never called us. It literally happens every day. It's a shell game. And the problem with the coordination of benefits denial, there's no appeal. You can be a perfect patient access department and ask every patient that walks in that door. Do you have any other coverage? Is this a work incident? Is this a vehicle related incident? Did you have a slip and fall? You can ask all the right questions, patient says no. Nope. Nope. No other coverage. You know, does your husband have coverage? Does your spouse have coverage? Nope. This is it. This is our coverage. You can do everything right and still get that coordination of benefits denial. And the patient will probably get a letter from the insurance doesn't make sense to them. Yeah. I've got insurance. What do you mean? You know, this could be covered under another insurance. And the patient's like, what do you mean? I don't have any other insurance. Yeah. And so they don't know what to do with it. It it probably just goes in the waste bin. Yep. And then we're stuck. So here we are working now for our biggest nemesis, the payer, working on their behalf for them to do their job. It's a horrible, horrible thing, and it's costing us. Hundreds of millions over a billion dollars a year across the country. Hundred I mean, it's just insane. The amount of money lost because eventually cannot continue to put effort into that claim because you got ten more that came in today. Right.

Your experts belong here

Every story in MarketScale Healthcare starts with a company putting its clinicians, service-line leaders, and field engineers on the record. Buyers are already reading this topic. The only question is whose experts they find.

Service-line buyers vet vendors quietly, and your clinicians become the proof they find while doing it.

Get your team featuredSee how it works15 minutes, straight to a calendar.

About the author

A
Acclara

Follow Healthcare Insights

Get new expert content in your inbox.

Healthcare: are you visible to AI?

Before they reach out, Healthcare buyers ask AI engines which vendors to trust. See how AI describes your company today, and where competitors show up instead.

Free workspace

You just read one Healthcare expert. Your company is full of them.

This article was produced through MarketScale. The same platform turns your clinicians, service-line leaders, and field engineers into the articles, video, and social content Healthcare buyers are searching for. Create a free workspace and see it with your own people. No credit card, no demo required.

NPS +73 · 1,000+ creators · 38+ countries

What you get, free

Your own MarketScale Studio workspace
One video edit a month, on us
AI writing, editing, and publishing tools
In-platform coaching to learn the system

More Healthcare Insights

Dental practice exits are turning into multi-year projects, not last-year decisions

Dental practice exits are turning into multi-year projects, not last-year decisions

Dental practice exits now take 3–5+ years of prep. Dental Economics says associate-to-buyout timelines often run three to five-plus years. That pushes revenue-cycle controls, buy-sell terms, and tax structure earlier, before a buyer appears.

  • 01A practical benchmark is emerging for succession: bringing in an associate with intent to buy can take a minimum of three years and often more than five, according to Dental Economics.
  • 02If accounts receivable looks “high,” it may be a bookkeeping and posting problem before it is a payer problem, a revenue-cycle diagnostic Group Dentistry Now says shows up frequently at scale.
  • 03Exit planning is now an operating system project: valuation, tax positioning, and transition support belong in the same workstream, because deal structure can lock in or foreclose tax options, per Dental Economics.

Sep 4, 2026

Scan.com’s $220M round makes imaging an API contract for plans and employers

Scan.com’s $220M round makes imaging an API contract for plans and employers

Scan.com closed $220 million in equity and debt. It’s expanding its U.S. imaging network plus API-based scheduling and results delivery. For health plans and employers, imaging is starting to look like a platform procurement and integration decision, not a directory problem.

  • 01If imaging access is bought via an API, the real spec becomes integration depth: two-way scheduling plus results routing into the EMR, according to Business Wire.
  • 02Scan.com’s mix of $90M equity and $130M debt earmarked for M&A and working capital points to a fast-changing imaging provider network, which can help access but demands discipline in contracting and integration testing.
  • 03The same week’s funding news for Elucid ($55M) suggests AI imaging vendors will keep pushing toward FDA-cleared workflow insertions, a different buying path than network-layer platforms.

Sep 4, 2026

MD&M West 2026 exhibitors pitch audit-ready, AI-ready device platforms

MD&M West 2026 exhibitors pitch audit-ready, AI-ready device platforms

MD&M West 2026 exhibitor messaging suggests compliance testing and AI-ready compute are becoming early decisions, not afterthoughts. Medical Economics described 2026 as a period shaped by rapid technological change, regulatory scrutiny and ongoing economic uncertainty. Medical Design & Outsourcing’s MD&M West 2026 preview points to exhibitors highlighting test equipment, contract manufacturing and other launch support services.

  • 01If a device roadmap includes AI features, the critical path shifts toward data and software evidence that regulators can audit, which means earlier lock-in of compute platforms and test plans, pulling verification and validation into supplier selection.
  • 02MD&M West exhibitor messaging suggests verification and validation capacity is becoming a procurement problem, with rentals and lab-ready gear positioned as a way to avoid booking delays and re-tests, according to Medical Design & Outsourcing.
  • 03With imaging and other new procedural and device concepts moving fast, manufacturing leaders should expect more frequent line-change decisions and component qualification work, as GE HealthCare's photon-counting CT CE mark reported by MedTech Dive and MDDI's New Technologies coverage illustrate.

Sep 3, 2026

Explore More Healthcare Insights

Read more expert perspectives from across Healthcare.

Browse Healthcare Hub

About the Expert

A
Acclara

For B2B teams

Your experts could be publishing here

Stories like this one run on content MarketScale captures from real practitioners. See how your team's expertise becomes coverage in Healthcare and beyond.

Book a 15-minute demo

Or call us. No forms required. We pick up. 214-945-2512