It seems that we have seen many inquiries for ancillary provider policies over the last few quarters.  As extenders become more prevalent in our healthcare system, exposure to professional liability claims stemming from their patient interactions inevitably rise as well.  The old paradigm of respondeat superior may not be the beginning and end of the discussion of exposure for an increasing number of ancillary providers with ever more complex employment relationships spread across multiple practices, facilities and exposures.

Historically, adding an ancillary risk to a primary physician’s policy on a shared limits basis was an easy solution to affordable professional liability coverage.  Now, with ancillary providers contracting with multiple physicians and being possibly unwilling to tie their coverage to any one physician (who may have just as dynamic situation as the ancillary), more and more healthcare extenders are seeking to control their own coverage.

The expense is similar to that which the front line physician markets will charge for shared limits on a primary physician’s policy and the ancillary provider is granted significantly more control over this increasingly important component of their professional lives.  By carrying an individual policy, the provider can be assured that their coverage is continuous and not tied to any individual employer or physician.  In the increasingly unstable work environment, this can be particularly beneficial to the provider who stitches together a work week at several practices or facilities.

Many program carriers do a superb job at writing this emerging risk and we would encourage ancillary providers to first contact their association endorsed carrier for coverage.  If this avenue is not open to ancillaries for whatever reason (claims, convictions, regulatory activity or substance abuse issues) we can secure coverage with top rated carriers with ease.

If you find yourself having more questions than answers when seeking coverage, give us a call!  We can help: 800-611-0793.

January 1st is the big day for professional liability insurance.  Even though most of the insurance carriers have moved away from the common renewal date concept, there are still enough physicians on the January renewal cycle to make it the “go to” date for determining how the rest of the year will look for pricing.

The soft market of the last few years was never really threatened during this renewal season as pricing held steady and in some cases was again pressed lower by intense competition for premium dollars.

The insurance consumer came out ahead, as carriers promised to hold the line with underwriting but again found themselves pricing risks lower to defend their books and try to snatch key accounts when possible.

With all of the soft pricing now becoming standard in the minds of insurance buyers, one must wonder how bad the hard market will hit when it finally does come.  Physician reimbursement is down overall, with premium reductions  helping to close that gap somewhat.  When premium pricing heads north as in cycles past, where will the extra dollars be found to meet the rising costs?

A quieter concern is the redrawing of underwriting guidelines over the past few years.  More and more suspect or borderline risks have been absorbed into the preferred pool and are quietly sitting there, paying well under value premium for superior coverage terms.  When the line is eventually drawn, how many of these risks will be ejected from the static pricing of the standard market into the wild and turbulent E & S environment?  How will they fare with the staggering multiplication of premium that is sure to follow their inevitable expulsion from the preferred ranks?

The pressure on this market has been building for several years.  New carriers entering the marketplace, consolidation and acquisition by major players have extended the market to its current position.  With ratios still in the black, carriers appear to be in no hurry to modify underwriting stances.  Soon, however, those ratios will not be so profitable and change must follow.

When that happens is the real question of the day.  Until then, consumers should make the most of their advantage, while keeping an eye on the coming market constriction.

The largest renewal date for professional liability policies is traditionally January 1st.  This is the result of a recently (within the last ten years in some cases) abandoned push from insurers to maintain a common policy renewal date.  Although the process is no longer in place with most carriers, the residual effects are still felt in the industry.  Many policies renew on Januar1st and the resulting scramble may make some physicians feel overwhelmed.

The holidays and end of the year business issues make this a particularly stressful time.  Considering changing a major expense like professional liability insurance is typically the last thing most insureds want to consider.  It is an arduous process with paperwork and documentation being required to secure quotes and the daunting nature of the endeavor is enough to make the boldest among us push it into the pile for “another day”.

This is where a broker can be worth his/her weight in gold.  Streamlined processes, multiple quotes from one application as well as strong motivation to find superior options all work to the advantage of the shopping physician.  The worst outcome is that your current coverage package is proven to be unbeatable.  The best outcome is significant reduction of costs to your practice; a welcome change in any season.

Give us a call today at 800-611-0793 to see what we can do for you.

This week we were able to find coverage for a pain management board eligible physician who is focusing on sedated detoxification for treatment of opiate addiction.  His prior insurer was unwilling to extend coverage and he was unable to eliminate this growing component of his practice.

We were able to find coverage with a top-tier admitted insurer at a comparable premium level with full prior acts and all the necessary coverages in place.  It was a great solution for our physician and a win/win with the new insurance company.

Give us a call at 800-611-0793 to see what we can do for you!

We get these calls all the time: A medical student from abroad or from a small university is seeking coverage to do a six week residency at a prestigious teaching hospital that will not let them in the front door without their own coverage.

The normal path is this: the distressed medical student will call the insurance companies in the state they would like to visit and are told the coverage they seek is not available.  The calls become more frantic and eventually I am on the other end of the phone.

Invariably: the conversation goes like this:

“I have good news and bad news.  I can get you the insurance, but it will be way more than you want to pay.”

“How much more?  There is no risk here, I am just going to be doing minimal patient interactions.  This is a huge program and I really want to go!”

“It will be at least 5k, and that is due up front.”

“For six weeks?!?  You have got to be kidding me!”

Unfortunately, that is how every one of these goes.  It is a catch-22 for the poor student: they can’t visit the program until they are covered and the coverage is way out of a poor medical student’s budget.

The sad thing is that the student is right on target here: it is only six weeks and it typically is very low to no risk activity that is being insured.  Unfortunately, the insurance industry is not built to respond to six week exposures and view everything with the “annual policy” perspective.  So, when only an annual policy meets a minimum premium, the student is stuck.  It is never a good conversation to have.

If there is any solution that I haven’t heard of or seen, I would love to know of it.  It is really frustrating to be the bearer of bad news to someone who has worked very hard to get into a great program and have the door slammed in their face by the insurance market’s failure to respond to unique coverage situations.

Do you have any thoughts, ideas or questions about this topic?  Give us a call at 800-611-0793 and let us hear them!

This week saw the end to nearly six months of work on a set of policies that looked a little like a spider web instead of an organizational chart.

Our client is a entrepreneurial physician who created a structure of several entities that were independent but highly inter-related.  Our challenge was to insure each of the entities individually while keeping an eye on the whole.  The danger lies in having one of the entities inadequately covered and becoming a chink in the armor.

We finally delivered four individual entity policies (the start date had been pushed back several times, as often happens) and several individual physician policies.  Along the way, we had multiple conversations with confused underwriters (not all the policies were with the same carrier) and even a few with a very patient client.

The outcome has been complete coverage for all involved entities and a very complex placement put to bed.  What can we do for you?  Give us a call to find out at (800)611-0793.

The number one question we get when a physician is considering a change from one carrier to another is about tail coverage.

Tail is such a complex and confusing topic that we will dedicate an entire post to it next time.  For now, let’s just deal with how carriers have made it easy to switch from one to another.

There are two ways to address the tail question when changing from one carrier to another:

1. The first is to buy tail coverage from your old insurance company.  This is expensive and not a very good option.  It is priced on a formula: your prior premium X 3 (rule of thumb).  It is not very attractive to move from one carrier to another for the purpose of cost savings if it will cost a king’s ransom to do it.
2. The second option is “Nose” coverage from the new insurance company.  The new carrier will issue a policy that includes coverage for prior acts that were covered under the old policy.  It is significantly less expensive and allows for one company to be responsible for any and all claims you may face (in most situations).

If tail coverage were the only option available in the marketplace, few physicians would ever make  a change.  Fortunately, insurance companies are eager to attract new clients and willingly offer nose coverage to ease the transition.

Long story made short: Tail coverage?  No need to worry.  Nose will do the trick nicely!  Give us a call to discuss how this may affect you and your coverage at 800-611-0793.

Although the overwhelming majority of our clients are solo physicians and groups, we sometimes are asked to work with other licensed healthcare professionals who are in a bind.

Last week we were able to successfully place a Nurse Practitioner who was opening an ambulatory clinic in the Northwest but was unable to secure coverage from the direct insurers who frequently issue policies in the state.  The NP had a long-lingering accusation involving prescriptions and an allegation of chemical abuse from the state’s licensing board.  Although the accusation hadn’t progressed to a decision in nearly two years, insurance companies were leery of insuring the risk due to possible defensibility issues should a claim arise.

To make matters a little more complicated, the NP hadn’t planned on the seemingly endless delays in securing coverage and was ready to open the doors of the practice.  The only holdup was the medical malpractice coverage.   No reimbursement contracts could be finalized without the coverage.  This would have proven to be a paralyzing limiter on cash flow for a start up business.

We secured coverage in one week for the NP.  The conditions of coverage and premium were the best available and allowed the practice to open.  Our NP insured was able to focus on what was important: providing care to the clinic’s patients.

Call us now to see how we can help you: (800) 611-0793.

Sometimes we have an opportunity to work with a completely different type of client seeking insurance.  The front line carriers have all declined to offer terms but won’t be specific about why.  In some cases the explanation as to why an admitted, physician owned or controlled carrier can’t or won’t offer terms are so generic as to be valueless to help the physician in future discussions with other insurance companies.

This week’s blog addresses that situation.  We got a frantic call from a physician with impeccable credentials who had recently been offered a position at an insurance consulting firm that performs utilization review.  He would be the medical director of the firm, with no direct patient care whatsoever.  This would be a part time position, in addition to his current practice.

Naturally, he called his current insurance company to have the new position covered under his existing policy.  They declined to allow coverage, citing an unwillingness to insure medical directorships.  He received the same response from a few other carriers with whom he was familiar.

His call to us was all too familiar: “There is zero risk here!  I cannot imagine a set of circumstances where I would ever get sued.  What is going on?”

He had fallen victim to the dreaded “medical director” decline.  Because insurance companies have been sued successfully in the past for medical directorship practices that were less than responsible, the default answer has become an automatic declination of the entire class.

There are physicians who will agree to provide minimal involvement in a ambulatory patient care setting for a hefty fee.  They leave the day to day patient care to the ancillary staff (who often own the walk in clinic or urgent care center in a 51/49% split with the physician) and simply sign charts in the back while cashing checks.  Essentially, the medical license they hold is rented out for a fee to the ancillary providers, to allow them to operate for all intents and purposes, as physicians.

This type of arrangement has significant issues and has yielded some terrible malpractice claims and settlements.  Naturally, insurers won’t touch these models, nor should they.

However, sometimes underwriters will throw the baby out with the bathwater.  It is easier to slam the door completely and be assured of zero losses under the “Medical Director” classification than it is to individually underwrite each application and pick out the best of the best.

Such is the case with our physician.  Because the well has been tainted by the bad actors who went before him, our insured was scrambling to cover a very simple risk in a very short period of time.

We were able to find him pure Medical Director coverage with a large national carrier for a minimum premium (the lowest premium the carrier will offer for insurance) of $5,000 per year.  This coverage excludes his daily practice of medicine and only covers him for his work at the insurance consulting firm.  There is a “firewall” between the two exposures.

This isn’t the best alternative (a no additional premium coverage extension under his existing policy would have been best) but it is the only one available in this market as of today.

We were able to solve his problem and allow him to accept the position.  What can we do for you?  Call us at (800) 611-0793 to find out!

We had a unique call and opportunity this week.  A Northwest US physician was traveling (had traveled already, in fact) to a Southern state for a very high level symposium.  The tuition for the event was significant and had been paid in full, with no refunds possible.

The physician was distressed to learn that his employer’s group policy would not cover him for the educational event (for a variety of reasons) and he would have to produce evidence of insurance to attend (it had been stipulated in the contract he had signed when registering).

We received the frantic call late Monday afternoon and had the application back from the physician and out to the carriers early Tuesday morning.  We had a quote from an “A” rated carrier in four hours and, with some minor tweaking, had the binder done and certificate issued for the physician with time to spare for his event.

Our physician had been doing all the work on this coverage and getting nowhere until we spoke.  Having dealt with this type of situation in the past, we were able to quickly locate a market, secure a quote and obtain coverage.

What can we do for you?  Give us a call at 800-611-0793 to find out!