Managing COVID-19 claims through the pandemic has been complicated. Centers for Disease Control and Prevention (CDC) and other guidelines continue to be updated, and healthcare systems have been challenged by increasing demand and understaffing. Given the changes and challenges, our response to obtaining supporting documentation for COVID-related claims has varied. This is necessary to balance each employee’s unique situation with public health advice as provided locally or through the CDC.

Our standard practice is that if someone completes a rapid at-home test, we ask for details surrounding their current symptoms preventing them from working and request that they upload a picture of the test results to our portal. We then let the employee know that physician verification of their symptoms and an inability to work is required, and we proactively make outreach calls to their provider to verify why they are unable to work.

In most cases, the employee and the provider have been in telephone contact over the illness, resulting in tele-documentation, which we consider acceptable to support the initial approval. If needed, we also solicit visual/audio observations of the employee from the provider during their telehealth visits (e.g., the member was winded during the conversation). We then follow CDC guidelines for illness, recovery, and quarantine. If the condition lasts longer than anticipated or there are complications preventing return to work after the first 10 days, we require additional supportive documentation.

We find this approach appropriately balances sufficient medical information to support a claim with the ongoing challenges of the healthcare system, the CDC guidelines for quarantine, and helping an ill employee suffering symptoms from COVID-19.