Medical Billing Forum
General Category => General Questions => : bumbleb July 11, 2012, 12:35:49 PM
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We have a patient that is going on COBRA Aug 1st. I know she keeps her same policy that she has now, just she will be paying and not her employer. Her insurance allows 20 PT/OT/etc visits per year. She has used 14 so far. So she just gets the 6 more visits, since its a continuation of her current policy? She has also met her annual deductible, so that would also still be met, right?
Thanks!
Bren
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Yes.. so long as her premium payment is made on time, the coverage is "continued" without disruption. Here is a tip when dealing with COBRA. Verify benefits every month, remember there is a grace period so you might verify she is covered on Aug 1, but she has a grace period for premium's and carrier can terminate her LATER and request monies back. There's no way for them to set a term date until after the grace period (usually 14-30 days). When I know a patient is on Cobra, I verify benefits for each visit to be safe. I ask two things: when was last premium payment and when is next due. This gives me some idea of what to expect. Many many times I'll send in a claim, they will pay and later after grace period is up, patient is terminated and we are left having to refund the carrier (from the term date) and recovering from patient. For non par carriers we have cobra patients pay up front to avoid this.
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What a timely question!!! I currently have a Blue Cross COBRA patient. What I do is the first week of the month, I send in an Auth Request for the previous month, along with the HCFA, and mail it in, asking for however many visits the patient saw the psychologist that month. kinda backwards, but Blue Cross is paying.
I like PMRNC's way better.
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Thanks for the great tips!
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COBRA is a pain in butt for us billers because they can authorize and even pay for services and later after the grace period if the premium wasn't paid the term date is retroactive and they request the monies back. :( That's why I verify with each visit and sometimes even that is not enough, it's a toss up which is why with our non par clients we get the money up front and file claim for them.