Getting healthcare retroactively covered under COBRA?

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iamlucky13
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Getting healthcare retroactively covered under COBRA?

Post by iamlucky13 » Fri Feb 16, 2018 12:10 am

I was recently laid off and received my COBRA notice a few days ago. We're in the process of making this shockingly expensive decision - family coverage is literally more expensive than our mortgage, and there's a maze of conditions and limitations to learn about and compare with the Marketplace and possibly Medicaid options. In short, it's not a decision to make overnight, especially while trying to also manage a job search.

Meanwhile, real life continues at its own pace regardless of bureaucratic timelines, so my wife took our youngest in for his 2 month checkup and vaccinations today, and found out when we were told we have 60 days to elect, and that coverage would be retroactive, it wasn't as simple as that.

The doctor's office said our insurance has already been cancelled and they would not let us see the doctor without alternate insurance or payment.

So I guess we could have paid the uninsured rate, but the receptionist couldn't explain how or even if we could ever be reimbursed for that.

When I was told COBRA coverage was retroactive, I interpreted that as meaning if I sought covered care during the election period, I was locking myself in to paying the COBRA premiums at least up through the months I sought care in. It sounds like in reality, since my insurance is already cancelled only 7 days after the COBRA notice was postmarked, "retroactive" coverage is actually a lie, and I have no coverage until any election I make is processed, even though I will then have to pay premiums retroactively to the date of loss of coverage.

The COBRA notice doesn't even address how to get care. Only premiums and deadlines. Theoretically I could call the insurer (Blue Cross Blue Shield), since their website isn't helpful, but past instances of doing so have at best been a big waste of time. I'd rather spend time job-searching than waiting on hold for a call center worker who either can't answer my question or will confidently give me incorrect answers.

So, I thought I'd see if any Bogelheads have experience with this situation and can clarify whether it is actually possible to get coverage for care during the COBRA election period.

Spirit Rider
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Re: Getting healthcare retroactively covered under COBRA?

Post by Spirit Rider » Fri Feb 16, 2018 1:18 am

Retroactive coverage is not a lie. You have a fundamental misunderstanding of what "retroactive" means, "effective on a prior date". COBRA does provide the option of "retroactive coverage" to the date when your prior coverage terminated. If your coverage didn't terminate there would be nothing to be retroactive.

When your prior coverage terminates your have "no coverage". COBRA allows you up to 60 days to elect coverage and 45 days to make the first payment which will be for entire retroactive period.

Unless and until you elect/pay for coverage you will have "no coverage". During this time you will have to pay for services at whatever uninsured rate the provider charges you.

If/when you elect/pay for COBRA coverage within the deadlines you will be made whole. Any provider charges will be retroactively adjusted to the insured rate and any covered charges paid/reimbursed and any resulting excess charges refunded to you. The provider has no discretion in this matter.

If you want coverage immediately, you will have to elect/pay for it immediately.

What COBRA allows you to do is defer the election/payment while looking for work or checking for alternative coverage. Then if your bills are less than the COBRA premiums during the lesser period of the COBRA deadlines, work coverage or other other coverage, you can opt not to elect/pay the COBRA premiums.

madbrain
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Re: Getting healthcare retroactively covered under COBRA?

Post by madbrain » Fri Feb 16, 2018 4:51 am

When I left my job a few years ago, and had an illness 2 days after my coverage was terminated, I went to Kaiser. They made me sign a form stating that I was in my COBRA election period and was agreeing to pay the premium. I was able to see the doctor and get my prescriptions that day, paying my regular copays. I didn't get the COBRA paperwork from my employer in the mail until a couple weeks after.

azurekep
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Re: Getting healthcare retroactively covered under COBRA?

Post by azurekep » Fri Feb 16, 2018 11:43 am

iamlucky13 wrote:
Fri Feb 16, 2018 12:10 am
The COBRA notice doesn't even address how to get care. Only premiums and deadlines. Theoretically I could call the insurer (Blue Cross Blue Shield), since their website isn't helpful, but past instances of doing so have at best been a big waste of time. I'd rather spend time job-searching than waiting on hold for a call center worker who either can't answer my question or will confidently give me incorrect answers.
Sorry to hear about your situation.

I once had to deal with COBRA but don't remember the details. I'm responding though to the other poster's mention of Kaiser. In my experience (which admittedly is dated), they are the most organized of the insurance/HMO organizations. If you have a choice, they probably are the best to deal with. IOW, unless something has changed, you might actually get reps who can confidently give the correct answers.

Of course, that experience was when I was actually already enrolled, but they seemed like a well-oiled organization who could possibly provide actual guidance. Maybe others could confirm/refute this impression I have.

I've found your posts among the most well-spoken on the board. Maybe you can write a book on "Navigating the Labyrinthine Bureaucracies" when it is all over. I'm sure Bogleheads would read it. :)

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Pajamas
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Re: Getting healthcare retroactively covered under COBRA?

Post by Pajamas » Fri Feb 16, 2018 11:57 am

iamlucky13 wrote:
Fri Feb 16, 2018 12:10 am
So I guess we could have paid the uninsured rate, but the receptionist couldn't explain how or even if we could ever be reimbursed for that.
I wouldn't expect the receptionist to know unless it were a very small private office and the receptionist also did the billing, if that even still exists. You would probably have to talk to their billing person or department or company to get information about that.

Most offices are going to require proof of coverage and payment of co-payment and/or deductible OR immediate payment if it is private-pay prior to a visit. Most offices would probably also bill your health coverage if you provided that information to them within a reasonable period and then refund the balance. Might take a few phone calls and a lot of patience, though. It's not uncommon for additional coverage information to be provided after the fact.

Big Dog
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Re: Getting healthcare retroactively covered under COBRA?

Post by Big Dog » Fri Feb 16, 2018 12:44 pm

spirt rider has it correct.
Theoretically I could call the insurer (Blue Cross Blue Shield),
Not likely. You will need to contact your former employer's HR. Only they -- or their outsourcer for COBRA) can enroll you retroactively.

iamlucky13
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Re: Getting healthcare retroactively covered under COBRA?

Post by iamlucky13 » Fri Feb 16, 2018 9:57 pm

Spirit Rider wrote:
Fri Feb 16, 2018 1:18 am
Retroactive coverage is not a lie. You have a fundamental misunderstanding of what "retroactive" means, "effective on a prior date".
My understanding of the word "retroactive coverage" included "active." Since nothing more was explained, either in my separation notice, or in my COBRA notice, nor anywhere I've been able to find online in the last 2 long days of searching for information, I foolishly assumed I was still able to visit my providers and decide on the ultimate details of how it would be paid for in the 60 day window. In retrospect, I feel really dumb about that, as cynical as I already was about the health insurance industry.

If I had known about this, I could have taken advantage of the coverage already paid for to bump up my 2 month old's well-child checkup and vaccinations to before the end of coverage. Instead I sat waiting for my COBRA notice like exactly the sort of sucker I suppose the ambiguous wording of the notice and all related documents were intended to take me for.
If your coverage didn't terminate there would be nothing to be retroactive.
Not knowing the other details you explained, it appeared to me there would be - retroactive payments for the coverage elected out of the limbo I thought it was in.
If/when you elect/pay for COBRA coverage within the deadlines you will be made whole. Any provider charges will be retroactively adjusted to the insured rate and any covered charges paid/reimbursed and any resulting excess charges refunded to you. The provider has no discretion in this matter.
I guess this makes sense in the context you suggest, but it has been really frustrating that this has never explained, and that I can find no resource corroborating it so far. I am continuing my consideration of my options assuming you are correct, but would appreciate if you can provide any links verifying it.

iamlucky13
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Re: Getting healthcare retroactively covered under COBRA?

Post by iamlucky13 » Fri Feb 16, 2018 10:13 pm

azurekep wrote:
Fri Feb 16, 2018 11:43 am
I'm responding though to the other poster's mention of Kaiser. In my experience (which admittedly is dated), they are the most organized of the insurance/HMO organizations.
Interesting to know. They also seem to be one of the least expensive in my area. The counterpoint I've heard is they can be pretty inflexible about some things. I also spent part of today mapping out Kaiser clinics in my area and they are relatively limited. However, I didn't notice any potentially necessary service missing within reasonable driving distance.

Due to familiarity with my prior insurer, I actually called up the sales department for the local Blue Cross Blue Shield affiliate to try to get them to convince me there was a good reason to select them even though they charge more and reimburse less, and all they could say was "keep in mind the wider variety of options you get in an EPO network compared to an HMO."

That sounds nice in principle, but not as much in practice when the premiums are 1/3 higher, and yet also the co-insurance is twice as high, and especially since the network they offer for individual plans doesn't cover ANY of our existing providers we were using under their group plan.
azurekep wrote:
Fri Feb 16, 2018 11:43 am
I've found your posts among the most well-spoken on the board. Maybe you can write a book on "Navigating the Labyrinthine Bureaucracies" when it is all over.
You're too kind, yet also too cruel for suggesting I torture myself with learning more about this industry than necessary to try make the coverage choice most appropriate to my situation, and identify pitfalls to avoid. I've come across quite a few - such not previously knowing that my employer's start of the year HSA contribution will put me over my limit if I don't select a qualifying plan, requiring me to file a correction before filing my 2018 return or else face a penalty.

BeneIRA
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Re: Getting healthcare retroactively covered under COBRA?

Post by BeneIRA » Fri Feb 16, 2018 10:44 pm

I am in the industry, so I can tell you how it really works. Your coverage terminates when it terminates, typically end of the month, end of the pay period or end of the last day worked. You are sent a COBRA notice and have 60 days from the date of the notice to enroll in the same coverage you had when you were active, retroactive to your last date on coverage so there will be no gap. It goes through the benefits administrator for COBRA. After you enroll, you have 45 days to then make your first payment. Theoretically, if someone doesn't know if they want COBRA, they could wait until day 59, then enroll, then wait until day 45 and make a payment.

Even if you enroll, behind the scenes, an electronic eligibility file still has to be sent to the carrier, which can take up to a week. Some COBRA Administrators will also not send a file to the carrier if there is not a paid thru date, otherwise people could easily just sign up, get services rendered, and then not pay.

As for Kaiser, they tend to be the least expensive plans because they are HMOs and they can control all of their own costs. The downside is that if you are outside of a Kaiser facility, you have no coverage. Also, I can't remember the last person I met who thought Kaiser was just "okay." You either love Kaiser or you hate Kaiser. Best of luck.

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