Disability Insurance Claims: 6 steps to make filing easier

When you got your disability insurance policy, you were preparing yourself for the unexpected. You likely never expect to need to make a claim, but if you do, understanding the process can make the experience less stressful.

This process of filing a disability insurance claim is similar across all types of disability insurance: long-term, short-term, group, and business overhead insurance. In this post, we’ll break down the process of filing a disability claim, important considerations to keep in mind, and what to expect during this challenging time.

  1. Eligibility: Your disability insurance policy’s definition of disability will help you understand your eligibility. “True own-occupation” is the recommended definition for physicians, meaning you would be considered disabled if you cannot work in your specialty, even if you’re making money at another job. Reviewing the terms of your policy will help you move on to the next steps in making a claim.
  2. Initial Steps: The next step is notifying your insurance company. This can be done by phone, email or online, depending on your insurance provider. You will need to complete and submit an initial claim form, which will typically include your statement, details about your disability, and your medical history.
  3. Evidence: A disability insurance claim requires medical evidence to substantiate your claim. Your claim will need to be backed up by medical records and a doctor’s statement of your condition. Substantial documentation of your condition and treatment will help the disability insurance process move forward more quickly. Your employer will also need to make a statement, detailing how your condition is affecting you at work and the wages you have lost. If you’ve stopped working, they will also need to provide your last date at work.
  4. Waiting Period: All disability insurance policies have what is called a waiting (or elimination) period, which is a specific period of time before benefits begin to be paid out. You are able, and encouraged, to start the claim process before your elimination period has ended in order to receive your benefits in a timely manner. If your claim is accepted before the elimination period has ended, you may need to wait a few more weeks to begin collecting your benefits.
  5. Claim Review: Your insurance company will review your claim after it has been submitted to determine if it is covered under your policy. This review will include an assessment of your statements and records. This process can take between a few weeks to a month or more. They may ask for follow up documentation, and any forms should be filled out promptly to reduce delay.
  6. Decision: If your disability claim is approved, then benefit payments will begin once the waiting period has ended. These payments will continue for as long as you are disabled, or as stated in your policy. If your claim is denied, the insurance company will send you a letter detailing why. Some common reasons claims are denied include:
    • Not meeting the definition of disability defined in your policy
    • Insufficient documentation from your physician
    • Your condition being excluded in your coverage (pre-existing conditions defined during the application process)

You have the right to appeal a denied claim. Your denial letter will include instructions on how, and the insurance company will likely request additional documentation to reconsider your claim.

Disability Insurance Awareness Month

May is Disability Insurance Awareness Month, and there is no better time to review your disability insurance coverage so you can be prepared in the event you need to file a claim. Physicians should have true own-occupation coverage that protects your specialty, high monthly benefits, and portable coverage that goes with you if you change jobs. Contact the MSVIA today for a no-cost quote or review of your coverage from a reputable, physician-dedicated insurance agent.

COVID-19 Updates for Virginia

via VDH

Dear Colleague:

This letter provides an update on COVID-19 vaccines.

FDA authorizes and CDC Recommends Simplified COVID-19 Vaccine Schedule

After the U.S. Food and Drug Administration (FDA) revised its emergency use authorizations for the Pfizer and Moderna mRNA COVID-19 vaccines, the Centers for Disease Control and Prevention (CDC) announced simplifying COVID-19 vaccine recommendations on April 19. CDC updated its Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States to provide detailed guidance for providers. We describe the key changes below and advise COVID-19 vaccinators in Virginia to implement these immediately.

  • All mRNA COVID-19 vaccinations will now use the bivalent vaccine formulations; monovalent mRNA vaccines are no longer authorized.
  • CDC recommends that everyone aged 6 years or older who is unvaccinated or has only received monovalent vaccines receive 1 bivalent mRNA COVID-19 vaccine.
  • Children aged 6 months through 5 years are eligible to receive at least one dose of a bivalent vaccine. The number of bivalent doses and timing will depend on the vaccine and their vaccination history.
  • Adults aged 65 years and older are eligible to receive an optional additional bivalent mRNA vaccine dose.
  • Individuals aged 6 years or older who have already received a bivalent mRNA vaccine are not eligible for an additional dose unless they are aged 65 years or older or immunocompromised.
  • Updated vaccine schedules for immunocompromised individuals will be available soon.
  • The updated guidelines do not apply to Novavax and Janssen (J&J) COVID-19 vaccines because they are not bivalent mRNA vaccines.
  • Healthcare providers can check the Virginia Immunization Information System (VIIS) to confirm patient’s vaccine history.
  • CDC and the Virginia Department of Health (VDH) are updating resources for patients and providers and plan to offer webinar training for providers. Training will be announced on CDC’s Clinician Outreach and Communication Activity (COCA) website or VDH’s COVID-19 Vaccine Healthcare Professionals website.

Table. Updated recommendations for bivalent mRNA COVID-19 vaccines for individuals who are not immunocompromised*

COVID-19 Vaccination Status Children aged 6 months to 5 years People aged 6 years or older
Has not yet received any dose Recommended to get at least 1 bivalent vaccine dose. The number of doses depends on age and vaccine type.* Recommended to get 1 dose of a bivalent vaccine.
Has received at least 1 vaccine dose Recommended to get at least 1 bivalent vaccine dose. The number of doses depends on age, vaccine type, and vaccine history.* Recommended to get 1 dose of a bivalent vaccine at least 8 weeks after last monovalent dose. If already received a bivalent vaccine dose, then an additional bivalent vaccine dose is not recommended.†
†Individuals aged 65 and older may receive an additional bivalent vaccine at least 4 months after first bivalent dose.

*For more detailed recommendations, refer to CDC’s Interim Clinical Considerations for Use of COVID-19 Vaccines in the United States. An updated vaccine schedule for individuals who are immunocompromised will be available soon.

Thank you again for your continued partnership. Please visit the Virginia Department of Health website for current clinical and public health guidance on COVID-19 and other information.     

Sincerely,

Parham Jaberi, MD, MPH
Acting State Health Commissioner

What practices need to know: DOJ message regarding ADA compliance

On Friday, April 14, 2023, The United States Attorney’s Office for the Eastern District of Virginia sent a Dear Colleagues Letter to remind healthcare providers of the rules surrounding the Americans with Disabilities Act (ADA).

Pursuant to the ADA, healthcare providers must ensure that communication with individuals with disabilities meets their required communication needs. Healthcare providers may not decline to provide treatment to an individual due to their communication disabilities and are required to take affirmative steps in providing reasonable accommodations including auxiliary aids and services (e.g., sign language interpreters, means of making visually delivered materials available to those with vision impairment, and speech-to-speech transliterators).

This client advisory from MSV counsel, Hancock, Daniel & Johnson, P.C., goes into greater detail of what practices need to know. Please read the advisory and share with your practice managers and legal representation.

Given the timing of The United States Attorney’s Office for the Eastern District of Virginia’s action—the MSV would strongly encourage its members to familiarize themselves with all aspects of the ADA and review their compliance with the statute.

Please contact us with any questions at [email protected].

HHS Announces New Divisions within the OCR

Big news: The U.S. Department of Health and Human Services, through the Office for Civil Rights (OCR), announced the formation of a new Enforcement Division, Policy Division, and Strategic Planning Division.

The OCR will now reflect the structure set by the U.S. Department of Education’s Office for Civil Rights

Why did the HHS form three new divisions? “OCR’s caseload has multiplied in recent years, increasing to over 51,000 complaints in 2022– an increase of 69 percent between 2017 and 2022,” said OCR Director Melanie Fontes Rainer. “…reorganization improves OCR’s ability to effectively respond to complaints, puts OCR in line with its peers’ structure, and moves OCR into the future.”

The Strategic Planning Division will coordinate public outreach to protect civil rights and health information privacy. They will also expand data analytics and coordinate data collection across HHS leadership. With the OCR being proactive and educating the public on their rights, now would be the time to make sure you are being proactive with HIPAA compliance.

The Importance of HIPAA Compliance

HIPAA violations can result in severe consequences, including fines, legal action, and damage to a healthcare organization’s reputation. Plus, it keeps our patients’ sensitive health information safe and private. Therefore, it is critical for healthcare providers and organizations to prioritize HIPAA compliance and regularly review and update their policies and procedures to ensure they are in line with the latest regulations.

Getting (and Staying) Compliant

Your Security Risk Analysis is the first thing the OCR asks for when they come knockin’. So why not beat them to the punch? With a Security Risk Analysis, you can:

  • identify and assess potential threats and vulnerabilities to protected health information (PHI)
  • evaluate the effectiveness of your organization’s security measures and policies

A HIPAA Security Risk Analysis is an ongoing process that must be regularly reviewed and updated to ensure that the organization remains in compliance. And the MSV’s partners at Abyde automate the entire process for you.

Abyde is the leader in HIPAA & OSHA compliance education and solutions for independent Medical practices. MSV members gain access to complimentary educational consultations, HIPAA/OSHA resources and special pricing for the Abyde software solution.

If you’re ready to make compliance stress-free, reach out to Abyde today.

COVID-19 Update For Virginia

via VDH

Dear Colleague:

This letter includes brief updates on COVID-19 reporting regulations, bivalent boosters, and the ending of the federal COVID-19 public health emergency.

Updates to Virginia’s COVID-19 Reporting Regulations

The State Board of Health’s emergency regulations for COVID-19 reporting expired on January 18, 2023. The Board updated the Virginia Regulations for Disease Reporting and Control (12VAC5-90-80 and 12VAC5-90-90), and the changes went into effect on January 18, 2023.  Below, we highlight important updates specifically related to COVID-19 reporting. The updated regulations and the Virginia Reportable Disease List can be referenced on the Virginia Department of Health (VDH) website.

  • Coronavirus disease 2019 (COVID-19 or SARS-CoV-2) was added to the Virginia Reportable Disease List.
  • Physicians and directors of medical care facilities are required to report to the health department not only when a person who is infected with or who is suspected of having COVID-19 is treated or examined, but also if the person is hospitalized or admitted into an intensive care unit.
  • Directors of laboratories and other entities that hold a Clinical Laboratory Improvement Amendments Certificates of Waiver (e.g., pharmacists) are required to report positive SARS-CoV-2 tests to VDH.
    • The report must be submitted electronically within three days of identification using either VDH’s available portal for laboratory reporting (VDH’s COVID-19 Point of Care (POC) Test Reporting Portal) or electronic laboratory reporting.
    • Negative SARS-CoV-2 test results are no longer required to be reported.
    • The required data elements for reporting were updated to add the patient’s ethnicity, phone number, and email address, in addition to the already reportable items, including race.
  • Severe coronavirus (e.g., infection caused by SARS-associated coronavirus [SARS-CoV] or middle eastern coronavirus [MERS-CoV]) continues to be an immediately reportable condition for physicians, directors of medical facilities and directors of laboratories.
    • With the updated regulations, persons in charge of hospitals, nursing facilities or nursing homes, assisted living facilities, and correctional facilities are now required to notify persons practicing funeral services if the deceased person was known to have had a severe coronavirus infection.

CDC Recommends Updated Bivalent COVID-19 Booster for Certain Children Aged 6 Months through 4 Years

On March 16, the Centers for Disease Control and Prevention (CDC) updated its Interim Clinical Considerations to allow children aged 6 months through 4 years who completed a 3-dose monovalent Pfizer-BioNTech primary series to receive a single bivalent Pfizer-BioNTech booster dose at least 2 months after completion of the primary series. For more information, please visit the CDC website.

COVID-19 Public Health Emergency to End on May 11, 2023

On January 30, the White House announced that both the COVID-19 national emergency and public health emergency (PHE) will end on May 11, 2023.  The end of the PHE could impact costs or insurance coverage of COVID-19 related tests, treatments, and vaccines.  Certain Medicare and Medicaid flexibilities or waivers will also end, but the timing of the end might be on or after May 11.

Emergency use authorizations for COVID-19 vaccines or treatments will not be impacted. Additionally, the distribution and allocation of federally purchased vaccines and therapeutics are not directly tied to the PHE. They will continue to be available, at no cost, to providers until they become commercially available. Virginia’s COVID-19 testing programs will continue to offer at-home test kits to vulnerable settings or populations as resources allow.

Despite the pending end of the federal PHE, COVID-19 remains an important public health issue. Together with our federal partners, VDH remains committed to monitoring trends and preventing severe illness and death from COVID-19. Please continue to encourage your patients to take measures to protect themselves and their families.

Thank you for your continued partnership. Please visit the VDH website for current clinical and public health guidance on COVID-19 and other conditions.

Sincerely,

Parham Jaberi, MD, MPH
Acting State Health Commissioner

SNOO is Granted FDA De Novo Approval For Keeping Sleeping Babies Safely Positioned on the Back

Marking a significant advance in infant safety, the U.S. Food and Drug Administration (FDA) has given De Novo approval to Happiest Baby’s SNOO Smart Sleeper. This is the first time the FDA has given De Novo approval to a product designed to keep sleeping babies safely positioned on the back. Babies who are positioned to sleep on the back are at a lower risk of SIDS.

Every year, 3,500 American babies die in their sleep from suffocation and unexplained causes including SIDS (Sudden Infant Death Syndrome). These deaths are collectively referred to as SUID (Sudden Unexpected Infant Death) and constitute the leading cause of death of healthy, full-term infants during the first year of life (90% of SUID cases occur in the first six months).

Tragically, the number of these deaths has continued unchanged at 3500 every year for over 20 years.

In the 1990s, doctors discovered that sleeping on the back dramatically reduced the incidence of SUID. Today, it is one of the key safe sleep recommendations of the American Academy of Pediatrics. The National Institutes of Health encourages back sleeping as “the single most effective action that parents and caregivers can take to lower a baby’s risk of SIDS.” And, the CDC advises that “babies who sleep on their backs are much less likely to die of SIDS than babies who sleep on their sides or stomachs.”

Despite this universal recommendation, almost two-thirds of SUID deaths still occur when babies roll to, or are placed on, the side or stomach. SNOO is the first and only bed that facilitates back (supine) sleeping. The SNOO Sack safely swaddles babies and attaches to the bed, keeping them securely on the back throughout sleep.

SNOO is for use by babies under 6 months of age or until they have demonstrated they can consistently roll from stomach to back during sleep. In a study of 1,012 infants, SNOO was found to reduce unsafe stomach sleeping by 91.5%. However, SNOO has not directly demonstrated a reduction in the incidence of SIDS/SUID.

“As a pediatrician for over 40 years, I’ve witnessed far too many times the unbearable pain of parents who placed their baby in bed at night, only to find them lifeless in the morning,” said Dr. Harvey Karp, co-founder and CEO of Happiest Baby, Inc. “Stomach sleeping leads to the tragic death of thousands of healthy infants every year. Yet, we routinely put babies in bed totally unsecured for 12 to 14 hours every day. Just as infant seats dramatically improve car safety, we hope to dramatically improve sleep safety by keeping babies on the back and reducing risky rolling.”

On March 30, 2023, the FDA granted the De Novo application of Happiest Baby’s SNOO Smart Sleeper:

“The Center for Devices and Radiological Health (CDRH) of the Food and Drug Administration (FDA) has completed its review of your De Novo request for classification of the SNOO Smart Sleeper, an over-the-counter device under 21 CFR Part 801 Subpart C with the following indications for use:

“The SNOO Smart Sleeper bassinet plus the SNOO Sleep Sack are jointly intended to facilitate a supine position during sleep. Infants who are placed in a supine sleep position are at lower risk of SIDS/SUID. The device is intended for home use by caregivers of infants from birth to 6 months of age, who are not yet able to roll over consistently.

“FDA concludes that this device should be classified into Class II. This order, therefore, classifies the SNOO Smart Sleeper, and substantially equivalent devices of this generic type, into Class II under the generic name infant supine sleep system.

“FDA identifies this generic type of device as:

“Infant supine sleep system. An infant supine sleep system is a device intended to facilitate a supine position during sleep for use in infants that are not yet able to roll over consistently. Infants placed in a supine sleep position are at lower risk of sudden infant death syndrome (SIDS) or sudden unexpected infant death (SUID).”

Click here for more information regarding the De Novo approval.

ABOUT SNOO

SNOO was created by renowned pediatrician and child development expert, Dr. Harvey Karp. Launched in 2016, SNOO helps lull babies to sleep faster and keep them sleeping longer. In recognition of these landmark advances, SNOO has received over 30 top honors, including the National Sleep Foundation’s Innovation of the Year and Fast Company’s World Changing Idea. SNOO has been featured at the London Design Museum, Victoria and Albert Museum, SF MOMA, and is in the permanent collection of the Smithsonian Institution.

In an advance in pediatric sleep science, SNOO uses specially designed, continuous rhythmic sensations that mimic the motion, sound, and tactile embrace babies experience in the womb. Although the current practice is to place babies to sleep in a dark, still, silent room, babies actually sleep better with constant motion, sound, and snug holding (e.g., rocking in a lounger, long walks in a carrier or stroller, car rides, etc.). This was shown in a large infant sleep study (7,157 babies, 0-6 months of age). It demonstrated that SNOO’s constant rhythms were associated with an unprecedented one hour per night average increase in sleep. Furthermore, by two months, SNOO increased the longest continuous period of night sleep from an average of five hours to almost seven hours; a 40% boost in the sleep most precious to new parents—and most helpful for infant well-being—consolidated, continuous sleep.

Hundreds of thousands of families have used SNOO as their baby’s first bed. Most parents obtain it directly through Happiest Baby’s rental program and thousands get a free, six month SNOO rental from their employer. Over 60 top American companies, including, JP Morgan, Activision-Blizzard, Snapchat, Children’s Hospital of New Orleans, and Under Armour, offer SNOOs to support new parents.

ABOUT HAPPIEST BABY

Happiest Baby is an LA-based company co-founded by Dr. Harvey Karp and Nina Montée Karp. It’s a

mission-driven company dedicated to protecting the health and wellness of children, parents, and healthcare workers across America and around the world. The company develops innovative, science-based products and content to solve every-day childcare challenges and to enhance the well-being of families and healthcare providers.

Dr. Karp is the author of the celebrated parent books and streaming videos, The Happiest Baby on the Block and The Happiest Toddler on the Block and the book, The Happiest Baby Guide to Great Sleep: Birth to 5,which have been used by millions of families and translated into dozens of languages.

In addition to SNOO, the company makes numerous other parent-support products, including Sleepea (an award-winning, “5-second” swaddle), SNOObear (a white noise, plush toy that aids infant/toddler soothing and sleep), and SNOObie (a white noise and nightlight device to improve a child’s sleep and teach mindful breathing, used from birth to school age).

For Inquiries: [email protected]

SOURCE Happiest Baby, Inc.

Expanded telehealth services are ‘here to stay’ in Virginia as public health emergency ends

As the federal public health emergency spurred by the COVID-19 pandemic expires this May, so will waivers that expanded the amount of health care services patients can access through telehealth.

But Virginia officials say most of the services the waivers allowed, such as being able to have virtual appointments instead of in-person visits at a provider’s office, have been signed into state law and are here to stay for both Medicaid enrollees and those with commercial insurance.

“Virginia really stepped up – the General Assembly codified many of the waivers that were put in place early on in the public health emergency,” said Dr. Karen Rheuban, director and co-founder of the University of Virginia Center for Telemedicine and a decades-long advocate for expanding access to virtual health care. When the public health emergency expires on May 11, she said, Virginia “won’t fall off the telemedicine cliff.”

Telehealth is an umbrella term for a broad spectrum of health care tools and services. That includes…

Read the Full Article at Virginia Mercury

SafeHaven Health and Wellness Coaching Certification

The Medical Society of Virginia is thrilled to partner with Georgetown University to offer the SafeHaven Coaching Certification program as part of Georgetown’s Health & Wellness Coaching Certificate. Download the program flyer.

Participants of the program will:

  • Be a part of the first cohort to expand the SafeHaven coaching network
  • Pave the way for privileged, protected access to care for all healthcare professionals seeking support
  • Receive up to 50 hours of CME upon completion (AMA PRA CATEGORY 1 CREDITS™)

Register for our upcoming information session

Tuesday, April 11, 2023 | 6PM – 7PM | REGISTER NOW

Want to learn more about this unique opportunity? Register here to join Georgetown faculty lead Petra Platzer, PhD NBC-HWC PCC, and MSV and SafeHaven leadership, to learn more the program curriculum and how to apply. 

Already interested? Apply to the course now!  

If you are unable to attend, this webinar will be posted to the MSV website! If you have additional questions about coaching, please reach out to [email protected].  

Increase in Candida auris and Carbapenemase-producing Organisms

via VDH.gov

Dear Colleague,

The Virginia Department of Health continues to respond to reports of cases and outbreaks of Candida auris (C. auris) and/or carbapenemase-producing organisms (CPOs). C. auris is an emerging fungus that presents a serious global health threat. It is often resistant to antifungal drugs used to treat Candida infections and can cause outbreaks in healthcare settings. This advisory provides an update on the current epidemiology of these organisms in Virginia and recommendations for prevention and control.

VDH is observing a concerning increase in C. auris and CPO cases in Virginia. While most reported cases of C. auris and CPOs remain concentrated in Northern Virginia, increasing cases and outbreaks in the Central Region and detection of cases in all regions of Virginia indicate healthcare facilities across the state should be on alert for C. auris and CPOs. Case data and additional information can be found on the VDH C. auris and VDH CPO websites.

bar chart of candida cases

Source – Cases – Virginia Electronic Disease Surveillance System, data entered by 3/14/2023. Data is preliminary and subject to change.

CPOs and C. auris can cause asymptomatic colonization in patients, which can later lead to infection and transmission of the organism to other patients within a healthcare facility. Co-colonization of CPOs and C. auris has also been frequently observed. CPOs are highly antibiotic-resistant organisms that can cause infections that are difficult to treat, and in some cases, infections are resistant to all classes of available antibiotics.

Patients at highest risk for C. auris and/or CPO colonization are those who reside in or who have had prolonged admissions to high-risk healthcare facilities (particularly long-term acute care hospitals or ventilator-capable skilled nursing facilities). Persons who have recently spent time in hospitals and have invasive devices (e.g., mechanical ventilation or tracheostomy, feeding tubes, or central venous catheters) are also at high risk.

Prompt implementation of infection prevention and control measures is essential to prevent patient-to-patient transmission of C. auris and CPOs in healthcare settings. VDH recommends the following actions for health care providers:

  • Be aware auris and CPO cases are on the rise and are causing outbreaks in healthcare facilities. Every region of the state has identified persons infected or colonized with C. auris or CPOs.
  • Review and implement prevention measures to limit the spread of C. auris and CPOs as recommended on the CDC C. auris website and the CDC Carbapenem-resistant Enterobacterales website.
  • Inquire about high-risk exposures in all newly admitted patients and consider auris and CPO screening and/or empiric contact precautions in patients at high risk, including those who:
  • Had close contact in a healthcare setting to someone diagnosed with auris or CPO infection or colonization.
  • Were admitted from a long-term acute care hospital or a ventilator-capable skilled nursing facility.
  • Had international healthcare exposure within the past year.
  • Immediately report any suspected or confirmed auris or CPO cases to public health by contacting your local health department per the Virginia Reportable Disease List.
  • Ensure the implementation of appropriate infection prevention and control practices:
  • All healthcare workers should have high adherence to hand hygiene.
  • Patients with suspected or confirmed auris or CPOs in healthcare facilities should be managed using contact precautions. Some residents in nursing homes might be eligible to be managed with enhanced barrier precautions instead of contact precautions.
  • When auris is suspected, use healthcare grade disinfectants that are registered with EPA for claims against C. auris (List P). Additionally, high-risk healthcare facilities should consider switching to a List P product prior to identification of C. auris due to increasing cases in Virginia.
  • Use checklists to identify who is responsible for cleaning each item and cleaning frequency (e.g., environmental services staff versus clinical staff).
  • Reinforce and audit core infection prevention practices in healthcare facilities.
  • Conduct periodic education on multi-drug resistant organisms and training on appropriate infection prevention and control practices to healthcare workers.
  • Communicate information about colonization or infection with auris or CPOs during care transitions within and transfers between healthcare settings.

Thank you for your partnership in HAI/AR prevention.

Sincerely,

Laurie Forlano, DO, MPH
Acting State Epidemiologist
Acting Director, Office of Epidemiology

Emergency Medicaid Authorizations are Live in Kepro

You can now request authorizations for inpatient stays for your Emergency Medicaid members in Kepro: https://dmas.kepro.com/

If you have already sent a spreadsheet to DMAS requesting an authorization due to a denial, they are working on those and will return them asap. If you have not yet requested an authorization, please use Kepro going forward for dates of service 7/1/2022 or later.