COBRA Issues

COBRA continuation coverage is governed by very detailed and complex regulations issued by a multitude of governmental agencies, including the Department of Labor and Internal Revenue Service. Payers must comply with very specific requirements when offering and administering COBRA benefits. Patients who elect COBRA often do so because of a significant need for healthcare. Recognizing this, unscrupulous payers employ tactics designed to stretch the bounds of the law to permit termination of COBRA coverage to the maximum extent possible. Termination of COBRA coverage often results in uncompensated care for providers, who are left with no payers to bill other than unemployed patients.

TGF’s experience and knowledge of the web of COBRA regulations allows us to enforce patient and provider rights in a way that providers and patients are unable to do for themselves. TGF is able to resolve single treatment situations for providers, but it can also work to reinstate COBRA benefits that were improperly terminated. Reinstatement allows providers to recover payments on a long-term basis in cases of ongoing treatment and provides patients with coverage to which they are legally entitled. TGF also works with providers rendering ongoing courses of treatment to implement procedures and protocols designed to avoid common COBRA pitfalls and payer tactics.

  • PAYERs must comply with specific guidelines when dealing with COBRA beneficiaries
  • TGF stays up-to-date on these complex regulations and uses the regulations to maximize benefits for our provider-clients’ patients
  • TGF can pursue balances or work to reinstate coverage when it was improperly terminated
  • TGF can provide guidance on practices to avoid common pitfalls of COBRA reimbursement issues