Cobra - who can pay for it?

JulieinGA

I have an employee in Massachusetts whose FMLA expired; the employee couldn't return to work, and benefits were subsequently terminated. I just received a phone call from the ex-employee's treating physician - who wants to pay the ex-employee's COBRA premiums. No doubt so that this physician can continue to charge in excess of $10K per month against our plan. Not a bad deal for the doctor - since the premiums only run about $300/month. We are self-insured, so everything charged against our plan comes directly out of our pocket. Therefore, I want to know exactly what my options are before responding to this request. I've been dealing with benefits for 5 years now and have NEVER received a request like this. Has anyone out there had a similar experience to share? Or advice?

Any suggestions would be greatly appreciated!

Hunter1

If the employee is still in her COBRA option period, I don't think it makes any difference where the money comes from. If you don't take it directly from her, they could just as well have the doctor pay her and she turns around and makes out a check to you. Quite a scenario, though! Good Luck!

LindaS

Agree with Hunter - as long as she's still in the election period, it doesn't matter where the money comes from, as long as it is paid. Sorry!

Theresa Gegen TX

But the employee has the responsibility to elect cobra and to get the payments in -- timely and in the form required. If the doctor wants to give money to the employee for payment, that is between the employee and the doctor. I would not act as a middle man between them. I would tell the doctor that you will communicate with the employee about COBRA, but not with the doctor. They can do whatever they want as long as you get the payment, that is between them.

You should not be in the position of having to notify the doctor is the payment is late, etc. The doctor is not the legal representative of the employee.

Good Luck!

Pearce

Anyone can pay for COBRA coverage on behalf of a qualified beneficiary. There is nothing in the regulations to state that the QB must make the payment themselves. Some states (medicaid offices) will pay the COBRA coverage for a QB if the medical condition and potential claims justify the COBRA premiums. I have had California pay on behalf of QB's in two cases. A mother, brother, doctor, lawyer or hospital can pay. You should have the QB sign the paperwork if they are physically able to sign. The QB could be physically incapable (in a coma) of signing.

Theresa Gegen TX

That is good to know. I never heard of the government paying for it, but I guess they want to save their medicare dollars too!

Rockie

I believe this physician would be brought up on charges of fraud and abuse if the insurance company finds out he is paying $300 a month premiums for a patient so that he can collect $10K in charges. He will soon find himself breaking big rocks into small ones, not to mention having his license jerked.

NaeNae55

Years ago I worked for a non-profit organization that provided health insurance to a specific group of employees (railroad). The company was over 100 years old. To belong, you had to be an active employee of a railroad (no family members), a retiree of the railroad, or the spouse of such a retiree.

One day the new CEO decided he had a good idea. We would open the Plan to everyone and would NOT require any proof of health. (As an ERISA plan, this was illegal.) So, an amazing number of indigent people with serious health problems joined. Since we had stupidly advertised in doctor's offices, their doctors helped them complete the forms and paid all the premiums. For the doctors, this was a really wonderful thing! Unfortunately, our CEO's money making idea brought the company close to bankruptcy. We had a problem with ERISA for having people who didn't qualify (non railraod), and since we had made agreements with all these people for coverage, we had a problem with ending our contracts. One by one we were able to kick these people off the plan, after of course we had paid all their health bills.

As I remember, the CEO left shortly after the consequences of his idea became clear to the board.

It doesn't matter where the funds come from, as long as the premium is paid timely the health plan doesn't have a choice.

Good luck!