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Monday, March 20, 2006

COBRA - Reality and Myth

Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA) health benefit provisions in 1986. The purpose is to provide continuation of group health coverage that otherwise might be terminated.

This appeared to be a wise option for me when I left my last employer and set off back into the world of consulting. Eventually I would start working on finding my own coverage, but as any parent of a child knows, you don't want to leave yourself open without coverage because you can almost guarantee your child getting sick (or so it would seem) during that time.

However, while COBRA gurantees the ability to GET the coverage, it does not guarantee CONTINUOUS coverage. A fact that left me without insurance while bringing my daughter to the doctor this weekend with a cold.

You see, your employer has 2 weeks to get you the proper paperwork once your relationship is terminated. You then have the balance of 45 days after that point to "elect coverage" (which I did within 3 days, it would have been sooner, but they made a few mistakes on the coverage form). I sent the forms back via Overnight Delivery. Well, now as it turns out they have another two weeks before they are required by law to complete this paperwork and provide the coverage, which they are apparently taking full advantange of.

I should step back here for a momment for some background. You see, my employer tried on their paperwork they sent me, to make payment due upon election of coverage. Something that they can not do, since COBRA states that I have 45 days to make payment. They were none to happy about this, so it would seem that they will now drag their heels as long as they can, although (wisely on their part I will admit), they certainly will not admit to.

So, now here it is 3 weeks after my coverage ended, and I still do not have coverage for my daughter, despite the promise of "Continued Covereage" that COBRA tells you that you may have.

The Doctor Visit

I will also take this opportunity pick on both the doctors and pharmaceutical industry while I am at it. An $85 office visit at the pediatrician involves my daughter being stuck sitting in a PACKED waiting room for well over an hour, for an appointment that lasts all of 6 minutes, while the doctor a. looks in her throat and b. Listens to her chest to hear if she is congested (something you can here when she coughs - no stethoscope needed). Write a Script, pay on your way out. Next! And of course, I was not done there, as we make our way to the pharmacy for...

The Prescription

So, prescription in hand, the trip is made to CVS Pharmacy. The script is for Cedax. This is the best of all worlds for my picky (read: pain in the ass) daughter who will throw up any medication that she finds revolting. The best of all worlds because, A. It works really well for her and she have virtually never relapsed when this was the medication prescribed, B. It is not (apparently) horrible tasting, and she can handle drinking and swallowing it without traumatic episode and C. It is a once-a-day so that forgotten doses are history and limits the events that can cause drama. So, I am happy overall with the product.

That being said, when I went to pay for the prescription, you nearly had to pull me off the ceiling I was so amazed. For a bottle of antibiotic that lasts 10 Days (that would be a grand total of 10 (TEN) doses), the cost was $128 dollars. Do the Math - $12.80 per dose! Now, I have generally been one to be critical of healthcare, and their nickel and diming of patients, expecially with the recent trend to things such as "tiered" coverage, where what they paid depended on whether the drug was a generic or "name-brand" and a preferred or "non-preferred" item, but I after this I am starting to think in this particular case that the healthcare companies (mine being Blue Cross Blue Shield), are not all that wrong. That is simply ABSURD! The last time I had to pay for this medication about 3 years ago (because who I was working for at the time, only had "mail-in" coverage which did not cover short term items such as this), the cost was $85/prescription (from the same pharmacy). I'm sorry, something is really wrong here. The only logic I can come up with is that pharaceuticals are building some sort of warchest against lawsuits (such as Vioxx), but hey... let's get real here. There has got to be some sort of regulations put on this industry.

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