Articles Tagged with insurance coverage

Even though most of us are still sheltering in place in an attempt to lessen the immediate spread and most severe health consequences of COVID-19, it is not too soon to start considering possible long-term health impacts that may arise in the wake of the coronavirus pandemic.

Because the virus affects many organs and systems within the body – from the lungs and cardiovascular system to the liver, kidneys and likely the brain – it now appears likely that at least some patients will suffer long-term physical symptoms.  These long-term and even permanent problems may result from the virus itself, the body’s own immune response or even medical interventions, especially respirators, or a combination of all these factors.  But whatever the cause, doctors are already seeing heart damage, kidney and liver damage and, unsurprisingly, lung scarring and damage in a number of COVID-19 patients who are no longer actively infected.

And these are still early days. Some patients present during the illness with serious neurologic problems such as strokes and encephalitis, as well as other more mild neurologic symptoms such as dizziness, headache and loss of smell.  There have been reports of some patients suffering from Guillain-Barré Syndrome, an auto-immune disease where the immune system responds to an infection by mistakenly attacking the body’s own nerve cells.  It seems possible that at least some of these patients may continue to suffer neurologic and autoimmune issues, and related pain, fatigue and cognitive difficulties for at least some time.

Millions of people are affected by mental illness each year. While 1 in 5 people will experience a mental illness during their lifetime, everyone faces challenges in life that can impact their mental health. As the increase in the number of COVID-19 cases affects our entire country, so too will the need for access to mental health treatment and awareness of mental health issues. So far, older adults, along with those who have underlying health conditions, have been hit the hardest by the COVID-19 outbreak, with many developing severe, life threatening illnesses. Another group that is expected to be acutely affected by the pandemic include those who have severe mental illness.

Mental illness is a real and treatable set of conditions that includes major depression, bipolar disorder, eating disorders, panic attacks, generalized anxiety disorder, attention deficit hyperactivity disorder, and schizophrenia, among dozens of others. These disorders are serious enough to significantly impact a person’s daily life functioning, whether at school, work or in their relationships with others.

Mental health issues often coincide with a unique set of challenges that make it difficult for people to access even the most necessities, such as food, medications, stable housing, and healthcare. Combined, all these factors put people with severe mental illness at a much higher risk for contracting and transmitting the new coronavirus and dealing with COVID-19.

On April 28, 2020, the U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) issued deadline relief and other guidance under Title I of the Employee Retirement Income Security Act of 1974 (ERISA) to help, among other groups, disability plan participants who are impacted by the COVID-19 pandemic, also referred to as the coronavirus outbreak.

The Department of Labor, Department of the Treasury, and the Internal Revenue Service issued a joint notice explaining the extension of time frames for healthcare coverage, portability, and continuation of group health plan coverage under COBRA, and time frames to file a benefit claim or appeal of denied claims.  They also issued COVID-19 FAQs for Participants and Beneficiaries that address a number of common questions concerning health and retirement benefits.

The final rule published by EBSA and submitted to the Office of the Federal Register (OFR) for publication contains information of the extension of certain timeframes under ERISA and the Internal Revenue Code for group health plans, disability and other welfare plans, pension plans, and participants and beneficiaries of these plans during the COVID-19 National Emergency.

The past few months have heralded an unprecedented situation. Millions of Americans are being laid off as COVID-19 shuts down businesses throughout the nation. This is frightening for everyone.  It is doubly difficult for workers who have physical or mental limitations.  For those workers, the specter of finding a new job in this economy, one that can accommodate their often significant limitations, may be overwhelming.

Workers experiencing health issues — including cognitive issues or mental illnesses — who have been having difficulties performing their jobs because of those limitations but have been fighting through them, may well be among the first to be laid off as underperformers. While these workers are in fact impressive in their drive to keep working in the face of daunting health issues, that very refusal to admit defeat may result in unemployment and a lack of income for them.

If you are among these workers, now is the time to evaluate whether a disability claim makes sense for you. While you still have access to your job-related insurance, you can preserve some of your income and access to health insurance.  If you have ongoing medical issues for which you have already been treating that significantly impact your ability to work, be it physical pain, chronic illness, depression, anxiety, or auto-immune issues, talk to your doctor about whether he or she would recommend disability for you.

The effect of COVID-19 on the lives of every American cannot be overstated.  What we cannot know yet is how those effects will continue into the future.  We buy insurance to protect us in the event of future calamities. A variety of different types of insurance could potentially be triggered by the varying effects of the disease.  As it can be hard to know what the future could hold, the points below summarize the different ways your insurance could be involved in COVID-19 repercussions in the months and even years ahead.

It is difficult to know with certainty the range of long term health issues that could be caused by COVID-19, as the virus has only plagued us for approximately six months. Doctors predict the long-term effects will be similar to other coronaviruses like SARS.  While 80% of sick patients had “mild” cases, of the 20% who did not, they could experience a variety of long term effects.  COVID-19 survivors are expected  to follow the path of severe respiratory issues often seen after recovery from other respiratory illnesses.  That could mean lung fibrosis, reduced lung capacity and difficulty breathing and fatigue. Preliminary data out of China demonstrates that 20% of patients hospitalized with COVID-19 had heart damage. Patients also experience increased blood clotting.  Early studies from Asia show that COVID-19 attacks T-cells in a manner similar to HIV. Doctors are also finding that close to half of those hospitalized for COVID-19 have blood or protein in their urine, which is an early indicator of kidney damage, and up to 30% of patients in New York and Wuhan lost some level of kidney function. Liver damage, intestinal damage, and neurological malfunctions have also been reported.

Health Insurance

Over the years, courts deciding ERISA cases involving accidental death due to autoerotic asphyxiation have issued mixed opinions as to whether benefits should be payable. In a recent decision, Wightman v. Securian Life Ins. Co., No. CV 18-11285-DJC, 2020 WL 1703772 (D. Mass. Apr. 8, 2020), a district court upheld the denial of accidental death benefits due to the insured’s death caused by autoerotic asphyxiation gone awry.

Plaintiff Anne Wightman sued Securian Life Insurance Company after it denied the accidental death benefit claim filed as a result of her husband, Dr. Colin Wightman. This policy expressly excluded death when caused directly or indirectly by, among other things, “suicide or attempted suicide, whether sane or insane . . . intentionally self-inflicted injury or attempt at self-inflected injury, while sane insane” and “bodily or mental infirmity, illness or disease.”

Dr. Wightman had been in therapy since the late 1990’s for his interest in sexual asphyxia. Dr. Wightman told his wife about his interest in “sex-related strangulation” in 2007 after he engaged in a sexual encounter that led to a complaint to the police, and Dr. Wightman losing his job. Dr. Wightman sought mental health treatment as a result from June 2007 through April 2010. He also was prescribed medication to help treat his addiction, which he took through 2015. The court noted that records from his mental health treatment highlighted Dr. Wightman as having “high risk sexual behavior [that] has led to possibility of charges for sexual assault.”

Obviously, the coronavirus pandemic has affected everyone to some degree, and that includes the insurance industry and the people who rely on insurance to protect themselves from disaster.

Fortunately, the California Department of Insurance has been active in an effort to protect policyholders who are affected by the pandemic. As we already reported, on March 30 the DOI directed health insurance companies to increase access to services delivered via telehealth during the current state of emergency.

On April 3, the DOI took even more significant action. It issued another notice, this time directed at all insurers doing business in California, regarding claim deadlines. The DOI instructed all insurance companies to stop enforcing policy or statutory deadlines on policyholders for claims or coverage until 90 days after the COVID-19 state of emergency has ended.

Millions of Americans have lost jobs — and often the health coverage that came with those jobs. Millions of Americans had their work hours reduced or have received drastic pay cuts, so monthly premiums that may have been manageable before are now out of reach. It is important to understand your options and take action right away, so you don’t have gaps in health insurance coverage.

First, find out when your coverage is ending. You may have coverage until the end of the month you’re laid off or longer, depending on your employer. After your employer’s coverage ends, you can usually continue your employer’s coverage (but pay much higher premiums) or buy a policy on your own. Your best choice depends on each policy’s premiums, coverage, provider network – and what medical needs you and/or your family members have.

Here are some things to consider when evaluating your options.

On March 30, 2020, California Insurance Commissioner Ricardo Lara and the California Department of Insurance (“CDI”) directed health insurance companies to increase access to services delivered via telehealth during the COVID-19 state of emergency.

The agency said that increasing the availability of telehealth will “lessen the strain on the supply chain, reduce the need to use scarce stocks of provider personal protective equipment and protect the ability of the healthcare workforce to provide care by limiting physical exposure to potential sources of infectious disease,” the notice states.

To support expanded telehealth, CDI said insurers should allow all network providers to use all available modes of virtual care delivery, including video and telephone-based communication. Insurers are also required to reimburse telehealth services costs at the same rate as in-person office visits, effective March 30, 2020.

You have a business, and you were a responsible business owner.  You insured it against a variety of possible calamities, and included business income interruption insurance so you could continue meeting your financial obligations even if there is a disaster.

But then COVID-19 hit, and the government put everyone in your area on lockdown. Maybe your business can’t operate at all remotely, or maybe it “just” has taken a huge hit as people stay home.  Regardless, now is the time you need your insurance.

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