Home Forums Discussions General Discussion HIPAA, COBRA, EIEIO

Helath insurance portability, COBRA extensions, etc arent what they areadavertised to be.

I recently left my previous position as an employed physician with a clinic and re-entered private practice. Pretty gutsy at my age! I have not yet been able to secure health insurance coverage for myself due to the use of insulin to ecellently control my diabetes (A1c has never been >7 and usually <6). The diagnosis predated my clinic emplyment and coverage transferred from one employer to the next. But now that I'm the employer I can't get coverage; I even joined the local Chamber of Commerce to take advantage of "group" plans but several companies have turne d me down. And there is a lot of misinformation about how long COBRA covers.

Does anyone have similar experiences or suggestions? I have successfully managed to secure coverage for my family but am currently uncovered myself.

Thanks for leetting me vent.

Bruce.

Ouch. Some questions about your situation: First, do you have any employees, and if so would you offer them coverage? Second, can you qualify for a high deductible policy (not cheap but at least you'll have coverage for catastrophic things like CABG or Cancer). It's real important to not have a break in your coverage or your insurability will suffer (stupid system). Hopefully you COBRA'd immediately and still have the coverage in effect. We worked with an insurance broker (who happens to be a friend of mine) and he was able to get us a group plan when I first opened my own practice. If you haven't done this yet I suggest it as a good broker can explain what you need to have to get an employer policy (although my hunch is you already explored this option). I employ my wife in the practice as well as 2 other employees on the health insurance.

Oh, are you on any insurance plans? Perhaps you can try to get in the backdoor and speak with your provider rep and see if you can get special consideration. I'm not sure this would work and it would make you beholden to that plan, yet if all else fails it may be worth a shot.

I've copied a description of the law that created COBRA (Consilidated Omnibus Budget Reconcilliation Act of 1986) below. As you can see it defines the duration of coverage as 18 months (or longer). Good luck. (Also, although I didn't get the information below from this website, the Dept. of Labor has a page that summarizes the COBRA rules at

http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html

DURATION OF COVERAGE

COBRA establishes required periods of coverage for continuation health benefits. A plan, however, may provide longer periods of coverage beyond those required by COBRA. COBRA beneficiaries generally are eligible to pay for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage.

Coverage begins on the date that coverage would otherwise have been lost by reason of a qualifying event and can end when:

* The last day of maximum coverage is reached
* Premiums are not paid on a timely basis
* The employer ceases to maintain any group health plan
* Coverage is obtained with another employer group health plan that does not contain any exclusion or limitation with respect to any pre-existing condition of such beneficiary
* A beneficiary is entitled to Medicare benefits

Special rules for disabled individuals may extend the maximum periods of coverage. If a qualified beneficiary is determined under Title II or XVI of the Social Security Act to have been disabled at the time of a termination of employment or reduction in hours of employment and the qualified beneficiary properly notifies the plan administrator of the disability determination, the 18-month period is expanded to 29 months.

Although COBRA specifies certain maximum required periods of time that continued health coverage must be offered to qualified beneficiaries, COBRA does not prohibit plans from offering continuation health coverage that goes beyond the COBRA periods.

Some plans allow beneficiaries to convert group health coverage to an individual policy. If this option is available from the plan under COBRA, it must be offered to you. In this case, the option must be given for the beneficiary to enroll in a conversion health plan within 180 days before COBRA coverage ends. The premium is generally not at a group rate. The conversion option, however, is not available if the beneficiary ends COBRA coverage before reaching the maximum period of entitlement.

I've only been in practice 2.5 months. No "group" plans. Already tried the HD plan and I don't mean "high definition". No break in coverage yet but I have to get a plan within 60 days and 30 das are already gone. I like the idea of "backdoor" coverage but the carriers around here aren't provider friendly, but will try. Thanks.

Bruce.

Funny but this didn't post the way it looked on my screen as i typed it!

Also