Within Congress's passage of the Employment Retirement and Income Security Act (ERISA) was the Consolidated Omnibus Budget Reconciliation Act (COBRA), through which group health plans by employers are obligated to provide employees temporary health insurance at no more than 2% above the full costs, when that employee's job was terminated (resulting in what would otherwise be the termination of their medical benefits).
As a social scientist lately occupied with health policy, I was well aware of this program but had not experienced it firsthand until recently. The disastrous experience seems to warrant discussion both as an academic and as a frequent patient.
For starters, their checks are deposited separately from the processing of patient information, meaning that they can deposit a $700 check without confirming that they have the needed information to send to the insurance company to guarantee coverage. In fact, they can forget or otherwise err in processing information (as they did with me) despite having deposited such a large sum of funds (for perspective, it is approximately the median rent of a one-bedroom apartment in the United States), and absent the patient information in their database, they have very little if any way to look one up in the event of a complaint about lack of insurance coverage, and no way for the insurance company itself to know that one is entitled to coverage.
If one does need medical care in a hospital setting (as I did), with the still-pending status of COBRA, one gets the additional stressors of daily visits from hospital case managers informing them of lack of coverage, and several calls afterward from the hospital in its effort to recoup payment. Hospitals are hardly at fault for this, and have a vested interest in both patient care and reimbursement with which the slowness of this process interferes.
Absent insurance coverage being renewed (they will tell you that it is backdated to the first day of the month for which payment was provided, and that is true, but there are important caveats), one cannot obtain coverage for prescription medications, as insurance benefits must be verified by the pharmacy before they are applied to one's payment for medication. While some medications may be cheap out of pocket, others most definitely are not, and regardless the patient population for which COBRA is designed is those who are unemployed/between jobs, and thus presumably do not have the disposable income to spend on excess medication costs. And needless to say, any out-of-network claims are not processed by the insurance provider because one is no longer appearing, from their perspective, to be covered.
The number of calls to COBRA that can be required to sort out the details of one's case are astounding. They do not reach out to one with any speed, so it is largely the burden of the patient to follow up and ensure that information is being processed. In one instance, they neglected to process the form altogether. In another instance, they neglected to mention that the patient date of birth was missing, and that missing information precluded sending any information to the insurance provider (an information omission of which I was never informed until calling at my own initiation to follow-up). The birthdate and any other information changes cannot be made over the phone as with any other carrier with whom one might need only answer a few questions for security reasons. Rather, one must go online for forms, they must be filled out, printed, and mailed or faxed. All told, it required two case reference numbers, four customer service representatives, five weeks, and two mailed letters to guarantee insurance coverage for the month of July, meaning that it will be confirmed after the benefits lapsed, meaning that the prescription drug benefits were effectively nonexistent (at a time when many people struggle to afford needed medications, a non-adherence problem that produces a number of medical problems of its own for many Americans).
Programs such as this are meant to protect those who are vulnerable -- those who are poor, who have lost their jobs, and who need healthcare. These are likely not the people who will navigate well a labyrinthian system with several letters, case managers, micromanaging the information transmission among patient, employer, COBRA, insurance providers, and physicians.
There are many problems in the United States that are incredibly difficult to solve. Much of our added healthcare costs from which we do not reap the benefits can be attributed to costly procedures (much more costly than in many other countries) and costly medications. Too many people are underinsured, facing high deductibles and other out-of-pocket costs. We have marked income inequality and wage gaps education gaps and health inequality. These are problems that have taken years to address and will take many years still. Addressing this bureaucratic red tape should not.
As a social scientist lately occupied with health policy, I was well aware of this program but had not experienced it firsthand until recently. The disastrous experience seems to warrant discussion both as an academic and as a frequent patient.
For starters, their checks are deposited separately from the processing of patient information, meaning that they can deposit a $700 check without confirming that they have the needed information to send to the insurance company to guarantee coverage. In fact, they can forget or otherwise err in processing information (as they did with me) despite having deposited such a large sum of funds (for perspective, it is approximately the median rent of a one-bedroom apartment in the United States), and absent the patient information in their database, they have very little if any way to look one up in the event of a complaint about lack of insurance coverage, and no way for the insurance company itself to know that one is entitled to coverage.
If one does need medical care in a hospital setting (as I did), with the still-pending status of COBRA, one gets the additional stressors of daily visits from hospital case managers informing them of lack of coverage, and several calls afterward from the hospital in its effort to recoup payment. Hospitals are hardly at fault for this, and have a vested interest in both patient care and reimbursement with which the slowness of this process interferes.
Absent insurance coverage being renewed (they will tell you that it is backdated to the first day of the month for which payment was provided, and that is true, but there are important caveats), one cannot obtain coverage for prescription medications, as insurance benefits must be verified by the pharmacy before they are applied to one's payment for medication. While some medications may be cheap out of pocket, others most definitely are not, and regardless the patient population for which COBRA is designed is those who are unemployed/between jobs, and thus presumably do not have the disposable income to spend on excess medication costs. And needless to say, any out-of-network claims are not processed by the insurance provider because one is no longer appearing, from their perspective, to be covered.
The number of calls to COBRA that can be required to sort out the details of one's case are astounding. They do not reach out to one with any speed, so it is largely the burden of the patient to follow up and ensure that information is being processed. In one instance, they neglected to process the form altogether. In another instance, they neglected to mention that the patient date of birth was missing, and that missing information precluded sending any information to the insurance provider (an information omission of which I was never informed until calling at my own initiation to follow-up). The birthdate and any other information changes cannot be made over the phone as with any other carrier with whom one might need only answer a few questions for security reasons. Rather, one must go online for forms, they must be filled out, printed, and mailed or faxed. All told, it required two case reference numbers, four customer service representatives, five weeks, and two mailed letters to guarantee insurance coverage for the month of July, meaning that it will be confirmed after the benefits lapsed, meaning that the prescription drug benefits were effectively nonexistent (at a time when many people struggle to afford needed medications, a non-adherence problem that produces a number of medical problems of its own for many Americans).
Programs such as this are meant to protect those who are vulnerable -- those who are poor, who have lost their jobs, and who need healthcare. These are likely not the people who will navigate well a labyrinthian system with several letters, case managers, micromanaging the information transmission among patient, employer, COBRA, insurance providers, and physicians.
There are many problems in the United States that are incredibly difficult to solve. Much of our added healthcare costs from which we do not reap the benefits can be attributed to costly procedures (much more costly than in many other countries) and costly medications. Too many people are underinsured, facing high deductibles and other out-of-pocket costs. We have marked income inequality and wage gaps education gaps and health inequality. These are problems that have taken years to address and will take many years still. Addressing this bureaucratic red tape should not.
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