COBRA – Reality and Myth
Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in 1986. The purpose is to provide continuation of group health coverage that otherwise might be terminated.
This appeared to be a wise option for me when I left my last employer and set off back into the world of consulting. Eventually I would start working on finding my own coverage, but as any parent of a child knows, you don’t want to leave yourself open without coverage because you can almost guarantee your child getting sick (or so it would seem) during that time.
However, while COBRA gurantees the ability to GET the coverage, it does not guarantee CONTINUOUS coverage. A fact that left me without insurance while bringing my daughter to the doctor this weekend with a cold.
You see, your employer has 2 weeks to get you the proper paperwork once your relationship is terminated. You then have the balance of 45 days after that point to “elect coverage” (which I did within 3 days, it would have been sooner, but they made a few mistakes on the coverage form). I sent the forms back via Overnight Delivery. Well, now as it turns out they have another two weeks before they are required by law to complete this paperwork and provide the coverage, which they are apparently taking full advantange of.
I should step back here for a momment for some background. You see, my employer tried on their paperwork they sent me, to make payment due upon election of coverage. Something that they can not do, since COBRA states that I have 45 days to make payment. They were none to happy about this, so it would seem that they will now drag their heels as long as they can, although (wisely on their part I will admit), they certainly will not admit to.
So, now here it is 3 weeks after my coverage ended, and I still do not have coverage for my daughter, despite the promise of “Continued Covereage” that COBRA tells you that you may have.
The Doctor Visit
I will also take this opportunity pick on both the doctors and pharmaceutical industry while I am at it. An $85 office visit at the pediatrician involves my daughter being stuck sitting in a PACKED waiting room for well over an hour, for an appointment that lasts all of 6 minutes, while the doctor a. looks in her throat and b. Listens to her chest to hear if she is congested (something you can here when she coughs – no stethoscope needed). Write a Script, pay on your way out. Next! And of course, I was not done there, as we make our way to the pharmacy for…
The Prescription
So, prescription in hand, the trip is made to CVS Pharmacy. The script is for Cedax. This is the best of all worlds for my picky (read: pain in the ass) daughter who will throw up any medication that she finds revolting. The best of all worlds because, A. It works really well for her and she have virtually never relapsed when this was the medication prescribed, B. It is not (apparently) horrible tasting, and she can handle drinking and swallowing it without traumatic episode and C. It is a once-a-day so that forgotten doses are history and limits the events that can cause drama. So, I am happy overall with the product.
That being said, when I went to pay for the prescription, you nearly had to pull me off the ceiling I was so amazed. For a bottle of antibiotic that lasts 10 Days (that would be a grand total of 10 (TEN) doses), the cost was $128 dollars. Do the Math – $12.80 per dose! Now, I have generally been one to be critical of healthcare, and their nickel and diming of patients, expecially with the recent trend to things such as “tiered” coverage, where what they paid depended on whether the drug was a generic or “name-brand” and a preferred or “non-preferred” item, but I after this I am starting to think in this particular case that the healthcare companies (mine being Blue Cross Blue Shield), are not all that wrong. That is simply ABSURD! The last time I had to pay for this medication about 3 years ago (because who I was working for at the time, only had “mail-in” coverage which did not cover short term items such as this), the cost was $85/prescription (from the same pharmacy). I’m sorry, something is really wrong here. The only logic I can come up with is that pharaceuticals are building some sort of warchest against lawsuits (such as Vioxx), but hey… let’s get real here. There has got to be some sort of regulations put on this industry.
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6 Responses to “COBRA – Reality and Myth”
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Man, that sucks… I hate the fact that we don’t have a decent healthcare system in place, things like this could be avoided. The health insurance systems the US has are a joke.
While there are a lot of downsides to being military, the one upside is not having to deal with this. For as long as TPO is active duty, I have 100% free healthcare – including prescriptions and hospital stays.
And it’s stories like this that make me realize why I shouldn’t bitch too much about the sacrifices we have to make because of his decision to go career. YIKES!!!!
That sucks. I went through that (pre-baby thank God) after I was laid-off of my great job at the dept. store. And wouldn’t you know I got SICK!!!! I think I o.d’d on Dayquil and Nyquil, because it came out cheaper. With kids it’s a whole new game, we can’t get away with giving them “something else”.
Your daughter sounds like me when I was a kid taking meds ( i was on them like once a month for a variety of things). I once spewed grape dimetapp (blech!) about a foot in the air!
Look into Bluecross blueshield or any other provider for Individual/or child insurance. if you haven’t been without insurance for more than 60-90 days, you shouldn’t have any problems. I really hate health issurance crap.
Good Luck!
[...] only real problem came with some “in between” times, where I learned the perils of Cobra coverage (which is supposedly designed to take care of those specific times), as well as the dreaded, [...]
I know what you are saying … but consider yourself lucky that your company is providing any coverage. When I was let go by my company, a regional life insurance company in Philly, after sending the notices late, I sent back my election forms and then sent in my payment. The pament was sent certified and signed for on time, however, they claim to have never received it. Okay, not a big deal…except…I am a diabetic with a heart condition. Since they waited un til the expiration of 63 days to notice me of the cancellation, I, after 37 years of continuous coverage, now have been tagged with a pre-existing condition. Now I can pay for coverage for 12 months although it will cover nothing likely to ail me. My out of pocket drug costs run around $600/mo. And, as you have probably found out, ERISA lacks any meaningful penalties to discourage such bad =faith actions. You know, the candidates are trying to figure a way to help cover the uninsured yet the goverment not effectively protect the coverage of those who have tried to maintain it on their own. Our first president must be rolling over in his grave.