Currently there are few insurance companies that are open to covering multi-state
telemedicine exposures. This is because many carriers cannot write policies in states
outside of their state of domicile or the surrounding states for which they have
filed rates with the various Departments of Insurance. As such, the best bet is
to use a broker who has access to national carriers. This way, the physician can
cover, under one policy, the exposures in the states in which he wants to practice
today and have the flexibility to expand to additional states in the future on the
same policy. It is more cost-effective for the physician as well to have each exposure
on the same policy.
Many regional or state specific carriers therefore discourage the use of telemedicine
that crosses state lines as they are unable to continue to insure the physician.
The physician should therefore never assume that coverage is available in their
current insurance situation. Those who do may discover at the time of claim that
they are not insured.
Many physicians often falsely rely on their current policy to cover them automatically
for telemedicine malpractice insurance but physicians should review their policies
carefully to see if coverage is automatically extended for this activity.
Policies can have several areas that address coverage for telemedicine. The first
place many physicians go is to the definition of “Coverage Territory” or a similar
term. In some cases the definition will read “the entire united States and it’s
territories.” Physicians may rely on this to believe that they will have coverage
in place in the event of a claim but often times, there are further obligations
in the policy that supersede the definition of “Coverage Territory”.
As an example, the policy may state that the physician is covered only in the states
in which he/she is licensed. Further, the policy may state that the physician is
covered only in the states that the physician has advised the insurer in writing
that he/she is practicing medicine. Finally, the policy usually has terms that place
the duty on the physician to inform the insurer immediately in writing if he/she
performs any procedures or changes any part of his/her practice that was not written
on the original application. The latter can propose a problem as many insurers renew
physicians year after year without requesting an updated application.
To be safe, the physician should always call their broker when they change specialties,
procedures or any part of their practice.
There are many interstate practice issues that can arise with telemedicine. Primarily,
should the physician be licensed only in the state he/she is or where the patient
resides? In all cases the physician should consult the medical board in each state
to determine the state requirements. But beware, because the physician’s insurance
policy may require the licensure regardless of the state medical board’s answer.
Another issue that arises is making sure the physician keeps the information private
when using the internet or a cloud to review or transmit specimens, charts or patient
information. The physician should hire a good IT person to safeguard the data, develop
best practices for transmissions and email, and check to see if their insurer covers
privacy breaches. These types of suits are becoming more prevalent and the exposure
to a physician doing telemedicine can be significant.