To our surprise, coverage through The Doctors Company was denied.  The basis of the declination was the insurance company’s underwriting opinion that the MILD procedures was a “surgical” procedure and not included in the scope of practice for a pain management physician.  Assuming the easy solution entailed simply increasing the medical specialty classification to one the underwriter agreed included this exposure (in other words: higher premiums), a request was made to change the medical specialty classification.  This request was also denied as the carrier’s underwriter opined the procedure was intended to be performed by surgeons only and thereby they would not extend coverage under any circumstances.

The next step was to determine if other carriers might be able to extend the coverage for the client to perform the MILD procedures while maintaining the same or better coverage and pricing already in place.  After several inquiries and submissions and many, many conversations explaining the procedure, coverage was offered with another insurance company willing to extend coverage for the doctor to perform the MILD procedure within his practice.  All in all the additional premium to the doctor is $1,500 per year to include the MILD procedure.  A satisfactory result for all those involved.

As always, it is wise to contact your qualified medical malpractice insurance broker to determine whether you have the coverage you need.  Never assume your medical malpractice insurance covers you for any new procedures, contracts, locations or healthcare providers. As a matter of course, we will always look for the best coverage at the best price by querying several sources for you. We do all the running around so you can concentrate on what it is you do!

This was the hope back in the day when IPAs touted improved patient delivery systems.  In the case of IPAs favorable claim outcomes never materialized.  Will the same happen with ACOs?  Time will tell but in the interim we are working to take advantage of the possibility of lower rates from the nations best companies by developing group purchasing programs for our ACO clients.

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The aggregate limit for a physician with separate limits is $50,000; for an entity with separate limits, $50,000 to $250,000, based on group size. DataShield™ covers costs for:

• Information & network security liability — Protection against claims alleging unauthorized release of personal information, violations of information privacy law, or unauthorized use of/access to your computer system.
• Media liability — Protection against claims arising from material published on a Web site, in ads, etc., including allegations of libel, slander, copyright infringement, or patent violations.
• Regulatory privacy proceedings & regulatory fines & penalties — Coverage for defense of HIPAA violations, state information privacy law violations, etc; and for certain related fines and penalties.
• Customer notification & credit monitoring expenses — Coverage for expenses incurred through information breaches, including costs of notifying affected parties and providing them with credit monitoring services.
• Electronic data recovery & replacement expenses — Coverage for expenses incurred to recover or replace electronic data lost or damaged because of a computer virus, hacking or other system invasion.

Each of the five areas of coverage has its own $50,000 aggregate limit, subject to a $50,000 total aggregate limit.

Consider securing coverage that allow for some flexibility in the rating base to better accommodate individual and group needs.  For example, Medical Protective offers an occurrence-based, group policy that allows for a built-in tail if turn-over is likely.  The Doctors Company on the other hand can offer a group FTE policy with individual physician limits.  As yet another option, various companies are willing to offer a per encounter policy – though the drawback is the possibility of an audit billing at year end.

The coverage options are varied and complex and worth taking the time to understand.  In the end, intensivists MUST consider price, coverage, and carrier stability or face the risk of unexpected insurance expenses over the long haul.

Presidio Insurance Solutions – the experts in medical malpractice insurance solutions.

www.PresidioInsurance.com

The state of California attempts to provide consumers with the information they need to obtain coverage from an insurer they deem financial stable.  Generally, the total written premium (all the money to be collected on policies the company issues to health-care providers like physicians and surgeons) and the incurred loss (a figure which represents claims paid out by the insurer plus this figure can include an adjustment for reserves set aside for claims to be paid) can provide a picture of medical malpractice insurers financial stability.  However, actual financial documents are also available on the insurance department website for further inquiry into the financial stability of any medical malpractice insurance company.

The Doctors Company easily topped the group market share list of medical malpractice insurance companies in California with over $200 Million ($210,609,883) in written premium.  Norcal Mutual Insurance Company a distant second with over $150 Million in written premium.  Medical Protective, the Berkshire Hathaway company, comes in at just under $30 Million in California.  Its worth noting  The Doctors Company acquired SCPIE (AHI) and this acquisition is reflected in thewritten premium, and Berkshire Hathaway remains strong on a national level though the California market share reflects a conservative and stringent underwriting approach offering medical malpractice insurance only for the best of the best.  A newer player in the medical malpractice industry, Fairway RRG reported just over $7 million in written premium for all of 2009 (and even more worrisome is the Fairway RRG incurred losses reported of over $3 Million for 2009).

California market share data should be considered prior to purchasing medical malpractice insurance - lest you find yourself with a medical malpractice carrier touting great discounted rates without the money to actually pay the claims.  With the exorbitant costs of medical malpractce insurance, you definetely need to consider if you get what you paid for.  Always, always, always check the AM Best Ratings and financial data before purchasing a policy because in medical malpractice insurance there is always safety in numbers!

 Norcal Mutual Insurance Company recently stressed its position of early claim reporting by its medical malpractice insureds. “NORCAL Mutual continually stresses that there is no penalty for early reporting of incidents. Early reporting means we can put the insured at ease and confirm that the matter is covered. Equally important, it means we can help insureds avoid making the situation worse by, for example, making additions to the medical record or giving the record to the wrong party.”

From Norcal’s point of view early reporting of medical incidents by physicians and surgeons seems to make sense.  And certainly its important not to alter the medical record inappropriately or incorrectly (and ESPECIALLY if there is a possible claim brewing).  However, from a physicians or surgeons point of view, early reporting can have a negative impact on the claims history report.  Every incident reported to Norcal Mutual Insurance Company is reflected in the claim history of the reporting physician insured. This claim history report is traditionally provided to hospitals, managed care organizations, insurance companies, surgery centers, IPAs, etc. ).  The Doctors Company and Medical Protective (other leading writers of medical malpractice insurance for physicians and surgeons) have virtually the same approach of encouraging early reporting of medical incidents.  Check your individual policies to determine the exact reporting requirements and if in doubt contact your carrier claim’s department and determine how to proceed.  Every policy is different so its vital to understand your obligations in reporting incidents and/or claims.

 hCG, or human chorionic gonadotrophin is a glycoprotein hormone produced in pregnancy.

During pregnancy, the placenta produces hCG which allows the body to mobilize fat and use it as energy for both mother and fetus.

Performed within Alternative Medicine Practices, although the process appears harmless (and reportedly has has little to no side effects), within a medical weight loss regimen, medical malpractice insruance companies are ballking at covering the hCG procedure.  The traditional “admitted” market carriers (for example,  Norcal, Medical Protective and The Doctors Company) will generally exclude this procedure altogether when seen within the alternative medicine setting.  A separate policy is available to cover this exposure.  We recommend alternative healthcare facilties specifically disclose the procedure to their medical malpractice insurance company to make sure the procedure is covered under their policy.

Presidio Insurance has a Medispa & Alternative Healthcare Practices Program that extends coverage for the hCG procedure, as well as any other alternative procedures (i.e. aesthetics, acupuncture, naturopathic medicine, etc.).

Visit our website wwww.PresidioInsurance.com or call us directly (800)317-6411 to speak with a Medispa/Alternative Healthcare Program Specialist.

Presidio is pleased to announce that starting June 2010, Med Pro is offering special discounts and benefits to Pediatricians across the country.  Membership in select pediatric organizations will earn a discount for all Med Pro pediatric and pediatric-surgical specialists insured with Medical Protective.  Proof of membership is required.

Features of the MedPro Pediatric Program include:

• A pediatric member premium discount on  Medical Protective medical malpractice insurance policy
• An additional pediatric member discount for insureds with 10 years of claim-free experience
• Occurrence and Claims-made coverage options
• Various credits including: group practice; new-to-practice; part-time; risk management
• Risk management tools and educational programs (eligible for 5% credit upon successful completion – good for 3 years)
• Best defense and claims handling
• Real “Consent-to-Settle”*
• Free tail coverage at any age with just 1 year of coverage at a mature rate

Presidio Insurance Solutions is an approved Medical Protective agent offering dental and medical malpractice insurance coverage.

Presidio Insurance is pleased to announce Medical Protective’s new collaboration with AANA Insurance Services, formed to address the ever-growing insurance needs of Certified Registered Nurse Anesthestists (“CRNAs”) and committed to providing the best insurance products available to CRNAs on a nationwide basis. The insurance professionals at Presidio are here to assist in the application process…visit our website at www.PresidioInsurance.com or call us directly at (800)317-6411 to get your Rate Indication today.

NOTICE TO CONSUMERS
Medical doctors are licensed and regulated by the Medical Board of California
(800) 633-2322
www.mbc.ca.gov

The purpose of this new requirement (Title 16, California Code of Regulations section 1355.4) is to inform consumers where to go for information or with a complaint about California medical doctors.

Physicians may provide this notice by one of three methods:

Prominently posting a sign in an area of their offices conspicuous to patients, in at least 48-point type in Arial font. (See link “Sign for printing”, below, to print the actual notice.)

Including the notice in a written statement, signed and dated by the patient or patient’s representative, and kept in that patient’s file, stating the patient understands the physician is licensed and regulated by the board.

Including the notice in a statement on letterhead, discharge instructions, or other document given to a patient or the patient’s representative, where the notice is placed immediately above the signature line for the patient in at least 14-point type. The notice may be printed in sign form from the link below this article.

CCR 1355.4 (the actual regulation)

Sign For Printing

Presidio is providing this information as a courtesy for our California medical malpractice insurance clients.