A rheumatologist patient has been undergoing physical therapy in Woodlands Hospital, Houston for the last three years. She is a Canadian by birth, was married to an American husband and had three children, two girls and a male, all married and living in different states in America. She worked as a personal assistance in a business firm and had to retire early due to health complications. The husband is presently deceased, a situation, which has forced this widow to miss some of her therapy sessions and medications due to high costs. In this last session, she shares with her physician on the challenges she faces in buying the drugs in small doses, stating the high costs of the drugs as the worst of the problems she encounters. On inquiring, the physician notes that the woman has been buying the drugs personally, yet she ought to be under a health insurance cover. Her case is complicated as she relied on the husband for medical assistance before he succumbed to diabetes. The physician finds it challenging to advice her on any comprehensive medical cover, thus makes a phone call to Texas COBRA Insurance, a company under COBRA administration, and speaks with one of the COBRA representatives on the insurance cover, effective in the woman’s situation.
Physician: (dialing the phone and waiting to speak) Hello?
Administrator: Hello, I am Liz Manley from Texas COBRA Insurance company. How can I help you?
Physician: Hello, I am Dr Jim, Physician at Woodlands Hospital in Houston. I would like to inquire about your services concerning health cover for a patient.
Administrator: COBRA is an insurance plan, which was initiated as a fair and equitable balance for employees and dependants who do not qualify for other health plan cover (COBRA Insurance, 2016). This insurance program offers employees capability of providing some benefits of health insurance even after they have retired. The employee is able to access continually health coverage as long as she qualifies as a beneficiary.
Physician: I do not understand; you mean a person can still be under a cover other than the normal health covers?
Administrator: Yes, it is very possible with COBRA. As long as the patient was either an employee of the company or was a former spouse or a dependent child of the employee of the company, they still qualify for the cover. What you need to do is to trust us as we take you through the insurance process that may include billings, among other paper works (COBRA Health Insurance.Com, 2016).
Physician: What does the cover do? (Looks for a notebook to take down the message)
Administrator: COBRA enables either an employee or his dependents to access coverage even in the events when they would have been disqualified in other coverage.
Physician: Oh, yes! So you mean that my patient can access your services in the event she has lost her husband who was the main contributor to the cover. If possible, how else can your services assist my patient? What are the risks involved?
Administrator: Our Expert management is able to relieve your patient and the accounting department of the required tracking, billing, and collection. It is essential for individuals to understand the laws, guiding insurance coverage and insurance firms. This costs majority of them thousands of dollars in penalties and liability costs (COBRA Insurance, 2016).
Physician: Generally, what do your services include?
Administrator: We protect portal for employers and our participants, notify our participants of their rights to the employees or dependents, sending monthly coupons to employees, collecting premium payments and remittance, and tracking periods
Physician: Are there additional requirements you would need from the patient?
Administrator: The patient has to keep track of the notifications, periods, as well as billings. It is essential that the patient complete the application to get started, and notify us of any loss of her status such as death (COBRA Health Insurance.Com, 2016). Is the patient presently with you? I would like to speak with her directly and give her a quote if she is willing and ready.
Physician: I know that a person can fail to qualify for a cover in case of the death of the employee of the company who was the main contributor, in cases of termination for other reasons apart from gross misconduct…
Physician: A person can lose their cover in the event of legal separation, in situations where a child ceases to be dependent on the parents and in events where the beneficiary is entitled to Medicare benefits under social security act.
Administrator: That is very true. You must also note that our services are extended to majority of the companies that offer group health plans either directly or indirectly.
Physician: I want to believe that your coverage offers a variety of options other than the benefit of acquiring the same cover in similar situations as the active employees.
Administrator: That is very right. Our services will ensure that your patient enjoys benefits such as the right to choose her future health cover amongst the available options, and the right to extend her benefit period to 36 months.
Physician: Wow, this is so great news! Wait a minute; is there any chance that my patient can lose this cover at any given point before she acquires another?
Administrator: That is possible. The patient can lose her cover in case she fails to pay the premiums, terminates the coverage for any reason, or becomes entitled to Medicare coverage.
Physician: Great to hear from you. Allow me to discuss with her before she commits herself.
Administrator: That is great. In case she considers our plan, we would be overjoyed to serve her. Our contact address is Phone:
Physician: Thanks so much. It was great talking with you.
Administrator: You are very much welcomed, any time.
COBRA Insurance. Know your COBRA. 2016
COBRA Health Insurance.Com. Texas Cobra Insurance Resource. 2016