Deny COBRA Based on Dependent's Gross Misconduct??

[Christine Roberts]

Clinic X, an employer maintaining a self-insured group health plan, has received numerous threats from the estranged husband of a Clinic employee. The husband receives medical treatment at Clinic X, as the spouse of an employee.

The husband's highly volatile behavior has raised safety concerns at the Clinic. The employee has asked to terminate the husband's coverage, due to legal separation. Can the Clinic deny COBRA coverage on the basis of the husband's gross misconduct?

If not, can the CLinic simply refuse to treat the husband and pay for his coverage at another medical facility, for the COBRA period?

[mroberts]

As much as I wouldn't want to, it appears that you have to offer this spouse COBRA. The gross misconduct rule only applies to the termination of an employee or spouse, which doesn't seem to be the case from what you provided.

I would assume that health plan provides coverage at other facilities other than Clinic X, so the Clinic should be able to not treat a patient due to his behavior.

[Christine Roberts]

mroberts - (any relation?)

I agree w/your conclusion re: gross misconduct being limited to employees, and the obligation to offer COBRA. As far as denial of treatment (presuming treatment is provided elsewhere), evidently hospitals and medical facilities will "black line" a patient who poses a safety threat. Being a benefits attorney, not a specialist in health care providers, I am not sure if this practice is standard medical protocol. Presumably it is something that may be subject to state insurance laws. It would be interesting to know the answer.

[mbozek]

Making threats against a clinic or health care personnel should be considered a criminal matter and referred to the police. Any harassement or abuse should be dealt with as a threat to do bodily harm. Some state have specific laws against making threats to clinics or health care providers. Maybe the clinic can get a restraining order preventing the husband from setting foot into or around the clinic.

[Jbentz]

My two cents:

We (the clinic) can refuse to treat a patient, and we have for many reasons. We have also had restraining orders against patients, for the safetly of our doctors and our staff. You can also share PHI (Protected Health Information) when the doctor thinks the patient is at risk or others are in danger. We have also pressed charges. In the situation you have, if it were my employer, i would advise our clinic to do all of the above.

Check into your state laws for confidentiality and law enforcement guidelines.

On the COBRA issue, you have to provide the opportunity for coverage, but that is separate from where he receives treatment. Separate the the HR side of the clinic and the business side of it. For the HR side, smile, and provide the COBRA. On the clinic side, treat him like any other patient who is a threat to the work environment.

[Christine Roberts]

Excellent points both. Thanks for the comments.