By Vanessa Orr
Physicians and other medical providers are always looking for new opportunities. Some may choose to open satellite offices or take on medical directorships, while others may appear as expert witnesses or serve as independent medical examiners. And while these additions to their practices may provide lucrative results, it’s important that these changes in a doctor’s professional life be shared with their liability carriers.
“We run into this all the time as agents; a physician opens a satellite office in a different state or takes on a new position, and they are so busy that it doesn’t occur to them that they need to update their insurance policies,” said Tom Murphy, Senior Vice President/National Health Care Practice,
Danna-Gracey | Risk Strategies Company. “Unfortunately, the consequences can be dire.”
There are a number of reasons why a medical professional needs to update insurance information. One of the most common is when a doctor or practice adds a different location, or sets up a new location to provide ancillary services in a building that they already occupy.
“Doctors are trying to find ways to make more money and to build their practices, especially as reimbursements decrease,” said Murphy. “Some choose to open up medi-spas, or offer IV vitamin infusions or orthopedic joint injections because these are cash businesses that in most cases, insurance doesn’t cover.
“We find out later that they haven’t informed us or their insurance company,” he continued. “God forbid a claim comes in from this new practice and the doctor is doing things that were not indicated on their application or updated in the policy terms; their insurance will not cover them.”
While most carriers will allow doctors to do certain noninvasive procedures such as Botox, Restylene, vein procedures and other injectables if they can document that they have the necessary training certificates or experience, they will not cover services that are not FDA-approved.
“That’s a big no-no with physician insurance policies for obvious reasons,” said Murphy. “If a claim comes in for a non-FDA-approved procedure that goes wrong, the insurance company will have a problem defending that at trial.”
Doctors also need to update their policy information when they become medical directors for hospitals, long-term care or assisted living facilities, surgical centers and more. The vast majority of medical malpractice policies do not cover doctors who take on these directorships, and while some practices do have umbrella policies that cover their medical directors, others do not.
Physicians providing independent medical examinations (IME) or expert witness testimony must also update their policies to ensure that they are protected.
“A lot of doctors treat patients for work-related injuries or personal injuries and perform independent medical examinations on people who are not their clients,” Murphy explained. “An attorney sends them the patient’s medical records for review, and many doctors just assume that they are covered under their own med/mal policy. But they are not treating their own patients; they are giving expert witness testimony for someone else’s patient and there are separate policies for that.”
While many agents and insurance companies try to remind doctors about updating their policies when things change, it is up to the doctors to make sure that they have coverage for any new endeavor.
“What we want to avoid is doctors providing these services and getting claims that are going to be denied when they send them in,” said Murphy. “Even if they think they’re doing something innocuous, such as serving as an independent medical examiner or expert witness, they shouldn’t assume that they are covered.”
For more information, call Tom Murphy at (800) 966-2120 or visit www.dannagracey.com.
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