Our October meeting was a time to put faces to names as Lori Bosak & Maureen Maiuri from the Center for Health Care Financing spoke about Enhanced Coordination of Benefits (ECOB).  Lori had several fans in the room, and she was happy to meet people face-to-face.

The ECOB Unit is administered by the University of Masschusetts Medical School to provide benefit coordination to MassHealth members.  In plain language, this means that Lori (and other coordinators across the state) will work with a family’s existing private health insurance as well as MassHealth to get the greatest amount of coverage possible.  Lori stated that she works to help “the sickest of the sick”–children with complex medical needs who are high utilizers of health care services.  She helps families understand their MassHealth benefits and seeks to relieve their burdens by taking on battles with insurance companies.

MassHealth will help pay for private insurance premiums.  “Don’t let anyone tell you otherwise,” says Lori.  Massachusetts law requires that MassHealth members obtain any available group insurance.  She helps families enroll in available employee health insurance and will explore the possibility of COBRA benefits for dependents who are aging out of their parents’ plans.   ECOB will provide premium assistance for private insurance, including COBRA.  For families with complex medical needs, it is more cost-efficient for the Commonwealth of Massachusetts to make payments for COBRA coverage than to pick up the tab for medical expenses.

Lori urges families to contact her for assistance.  She knows that insurance claims get “lost” or are denied.  Lori works diligently to resolve any issues between families, their private insurance companies, their employers and MassHealth.  No wonder she has fans!

After the ECOB presentation, Dr. Sadof (@MDSadof) gave an update on his care coordination grant.  We were reminded of the upcoming Winter Wonderland Festival, to be held on Tue, Dec 2 from 4:30-6:30pm at Shriners Hospital for Children, 516 Carew St in Springfield, MA.  To donate your time, money or gifts, please contact Jane O’Brien at (413) 794-2085.  This event is sponsored by the Medical Home Work Group and Thom WRCP.