COBRA, no Starship

August 22, 2012 9:57 AM

How precisely do we handle payments for medical appointments until COBRA kicks in? And is there anything new I should know about COBRA post-Obamacare?

I am about to switch jobs. I'll have health insurance at my new job, but my domestic partner can't be covered at my new job right away. (They have different requirements, it'll take a while before we can meet them.) So in the meanwhile, he'll go on COBRA. I have talked to the benefits people and confirmed this is kosher, and we're prepared for the expense. But I do have a couple of questions that didn't apply the previous time I was on COBRA:

1) My partner has a couple of chronic medical conditions and will almost certainly require appointments and medication refills between now and whenever we actually get the COBRA paperwork, send it back with the check, and it all gets processed. How does this work? Does he pay for everything out of pocket, and if so, will we eventually get a check for the COBRA coverage? Or is it possible he can just tell his doctors that he's in the COBRA process election and they'll postpone submitting the claims, or something? I'm guessing the answer varies by doctor, but if it's always one way or the other, we'd like to know.

2) Bonus question: Since I was last on COBRA, we had this whole healthcare reform thing. Has that done anything new and different to COBRA coverage or procedures that we ought to know about?

(Should it matter: Pennsylvania, and opposite-sex domestic partners of many, many years. Would really rather not get driven to marriage by the sheer annoyance of paperwork if there are other options.)

posted by Stacey to health & fitness (7 answers total)

Buying COBRA coverage will back-cover you for all the days you buy it. So if you're currently insuranceless (but have the option of COBRA), you can go to the doctor now, fill out the COBRA paperwork within 62 days, and have back coverage. COBRA just extends your previous coverage, so when you go to the doctor, just use your old insurance card. To the doctor, it will be like nothing ever happened.

Unless...if the gap in time before you re-up COBRA is long enough, the insurance company might be all "we're not going to cover this because you don't have insurance," but that will just mean some extra phone calls and paperwork before it gets rectified. As long as you buy your COBRA within the timeframe, you shouldn't have any real issues.
posted by phunniemee at 10:04 AM on August 22, 2012

In case he's 55 or older, the Reinsurance Program for Early Retirees can help cover costs for some people, including COBRA premium payments by my understanding. Though like COBRA it's something the former employer has to set up first.
posted by XMLicious at 10:14 AM on August 22, 2012

In my health care system,we will continue to see the patient while the COBRA is processing. We've never had a problem. But if it falls through, the patient will be on the hook for the charges, so that is a risk that the patient takes on.
Talk to your partner's membership department. They will likely have a recommendation or policy about this pseudo-gap.
posted by SLC Mom at 10:45 AM on August 22, 2012

No matter how hard I try to pre-provide all the necessary information, I never manage it! We are both in our thirties, and both currently insured through the workplace I'm leaving.

Thanks for the information so far, this is helpful.
posted by Stacey at 10:46 AM on August 22, 2012

It depends on the doctor. If it is a doctor you know pretty well you might be able to convince them to just wait a week or something and then submit the claims. The pharmacy will probably not do this (unless you have a great local pharmacy that you have been going to for a while).

You can also ask them to bill you for the services, then when the bill actually comes call them up and tell them your insurance should cover that and give them the new ID numbers, etc.

You can also pay out of pocket for the expenses and then get a claim form from your insurance company and fill that out. Keep all the documentation in this situation as you might need to do a bit of fighting and waiting.
posted by magnetsphere at 11:44 AM on August 22, 2012

I'm not sure if this is related to Obamacare at all but there are all of these pharmacy chains that now have generic medication discount programs, under which some meds basically cost nothing. In my part of the country Walmart, Target, and pharmacies at large local supermarket chains have them, each with a slightly different list of drugs.

Another thought - if you expect the COBRA paperwork to be processed shortly you can just get one or two week supplies of meds filled to tide him over.
posted by XMLicious at 12:03 PM on August 22, 2012

When we switched from employer coverage to COBRA, we had to pay out of pocket and get reimbursed.
posted by KathrynT at 3:22 PM on August 22, 2012