Tuesday, March 22, 2005

A COBRA Primer – Addendum…

One last thing: In Part 2, I mentioned that there is no provision for claims to be covered after the last day of the 18th month. Here’s why that’s important:
Several years ago, I had a (life) client who was on COBRA. Now, this was the proverbial guy who had never been sick a day in his life. I had spoken with him several times about coming off COBRA early, and going onto an individual plan. His stock response was “okay, okay, I’ll get to it pretty soon.”
One day, about a week before the end of the 18th month, he suffered a MAJOR heart attack. His wife called, and told me the doc’s wouldn’t even operate because, and I quote, “his heart is mush.” He was in ICU, in pretty bad shape. His COBRA was thru Humana, so I called them to see how they would handle the claim after the end of the month. They replied (correctly, as I soon learned) that they wouldn’t; coverage would end at midnight on that last day.
But he’d still be in ICU, racking up a hefty-sized claim.
Fortunately, I knew that he would be a Federally Eligible Individual, and that we could get one of the HIPAA plans in place. I still recall walking into the ICU, briefcase in hand, and asking to see him. When I explained who I was, the nurses looked at me as if I’d escaped from the Psych ward upstairs [ed – insert punch line here]. Walking into his room, and seeing him with tubes and monitors arrayed before him, it was a truly moving sight. We finished the paperwork (well, all he really had to do was sign, which he could, and did), and we had coverage in place once Humana bowed out. But it is not an episode I’d care to repeat.
‘Nuff said.
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