Mind the Gap

COBRA—Consolidated Omnibus Budget Reconciliation Act—is aptly named. There is a bite to this program.

COBRA’s intentions are good: It permits individuals and families to continue getting health insurance for 18 months after they have been laid off. The Feds, in a rare show of compassion, have provided a 65% subsidy on the monthly COBRA payment. This subsidy truly makes the monthly payment affordable. I can attest to that.

Of course, this subsidy, like the employment benefit extension, is in doubt for the newly laid off. See http://www.kaiserhealthnews.org/Stories/2010/July/02/cobra-medicaid-medicare-congress.aspx

Unfortunately, one of the dirty little secrets HR people never tell you about COBRA as they are ushering you out of the door is that there is a definite gap in coverage.

Between the time you sign up for COBRA and when the COBRA administrator cashes your first check, there could be a gap of some three weeks. During that time, you are technically uninsured. Just try going to a doctor or hospital and telling them, “Well, I applied for COBRA and sent the check.” To them, you have no health insurance, and must pay in full upfront. It’s the sad state of our healthcare system that without health insurance, no medical facility or provider will treat you.

I found this out the hard way. In my entire life, I have never had to go to an emergency room. That is, until the two times I was between coverage periods due to a switchover to COBRA during the past six months. The first time was when my doctor wanted emergency tests and the other was when I fell and hit my nose so badly I thought I broke it. (Never hit the pavement with your face. The pavement always wins.)

When I told the benefits coordinator at my former employer about this, he said that such gaps are “unavoidable.”

If only illness and accidents were unavoidable. Fact is, our bodies don’t know there is a gap between coverage periods. While the COBRA provider takes its sweet time cashing your check, you CAN get sick and have accidents.

So what can you do when you need medical care during these “gap” periods?

Well, here are some suggestions:

Pay up or Suck it up. Only you know your tolerance for pain and discomfort. If you can handle it, by all means, wait until the coverage is official before seeking treatment. However, in many instances, that is simply not feasible.

Here’s what you can do if what is needed is a visit to a doctor’s office or ER:

You can pay the doctor upfront and wait to get reimbursed. Admittedly, this is a risky and daunting option for those of us who are unemployed. But it may be the only way to get needed treatment. I charged some medical supplies during a “gap” period in April and I’m still waiting to get reimbursed. So be aware that the reimbursement may take a while.

When I finally went to the ER for my nose the clerk allowed me to pay only the copay for an ER visit ($150) and told me to simply mail the bill back to the hospital with my insurance information when my coverage became official. Not every facility may be so accommodating.

If you've been going to the same doctor for a long time and are current with your payments, he or she may let you pay over time. My dentist has been kind enough to allow me to pay for some dental work a little bit each month.

The Public Option: But what if it’s a true, life-threatening emergency, something that requires immediate treatment? Find the nearest public hospital.

When I needed those emergency tests, my doctor sent me to the ER of a nearby public hospital. I was admitted for an overnight stay. All turned out fine, and the bill was eventually paid by the insurer.

And don’t be scared off by the term public hospital. TV shows sometimes portray public hospitals in the worst possible light. I found the opposite to be true. The care and the facility were fine. Remember, many big-city public hospitals are teaching facilities and the best medical centers are usually teaching hospitals. And if it’s not an emergency, there are also public clinics.

The only drawback I found was that you will have to wait an inordinate amount of time to get treated or seen by a doctor. After I was discharged, I had to go back to get the results of my test. It was four hours before I saw the doctor. Thankfully, the tests turned out negative, but waiting and wondering for four hours was torture!

So if you get hit by a bus, and bystanders want to help you as you lay on the ground, but you know you are in that gap period, just gasp and say, “Oh, just leave me here. I’m in an unavoidable gap period between my health coverage from former employer and COBRA. Cough…Gurgle…Phew….”

That may be the easiest option of all.