Primary Healthcare Integration
Q1. What information will we need to provide in order to get our customized insurance solution addressing our unique primary healthcare integration exposures?
Answer: Negley Associates has developed applications specifically tailored to address this exposure. The submission of a completed application and a copy of any contracts or agreements with your primary medical care partners will facilitate the development of a customized insurance solution for your organization.
Q2. We rely on our broker to deal with this. Haven’t they got this covered for us?
Answer: Many brokers are familiar with the trend towards integration and realize that there are serious insurance implications to consider and work out. We at Negley Associates want to work with your broker to make sure you get the coverage you need.
Q3. Is it imperative that we tell our broker that we are providing primary medical care services?
Answer: Yes. Please ask your broker to contact Negley Associates so we can get you the coverage you need.
Q4. If we are an FQHC providing behavioral healthcare services, does our protection from the government cover all of our volunteers, employees, and physicians?
Answer: Volunteers are not eligible for FTCA coverage. Also, there are eligibility restrictions relating to healthcare practitioner contractors under the FTCA. Additionally, a Scope of Employment that includes clearly defined written job descriptions must be formally submitted and approved by your organization’s HRSA Project Officer before an act or omission relating to the activities within the scope of employment may be covered.
Q5. If we are an FQHC providing behavioral health care services, does my protection from the government cover non primary medical care services?
Answer: Some services and activities are not subject to coverage under the FTCA. Only acts or omissions related to activities within the approved scope may be covered.
Q6. If we partner with or become an FQHC, are all of our programs and services covered by the FTCA?
Answer: No. Only the specific projects, employment activities and locations formally documented within the Scope of Project and Scope of Employment and officially approved by the Health Resources and Services Administration (HRSA) Project Officer may be covered by the FTCA. Whether they’re intentionally or unintentionally omitted, many behavioral healthcare related exposures are not covered by the FTCA.
Q7. If we partner with a Federally Qualified Health Center (FQHC) and they perform primary medical care services to our clients at our locations, aren’t we protected by their insurance?
Answer: Your organization still has a vicarious liability exposure that would not be covered by the FQHC’s insurance. For example, your organization could be named in a lawsuit because of a wrongful act of the primary care provider. Additionally, there are limitations to the activities and services afforded protection under the Federal Tort Claims Act (FTCA).
Q8. If we hire or contract with primary care physicians, are the primary care physicians required to carry their own insurance?
Answer: Many insurance carriers require that contracted physicians carry their own insurance. Just as Negley Associates does not make this requirement when it comes to physicians providing behavioral healthcare, Negley Associates does not make this requirement when it comes to physicians providing primary medical care.
Q9. If our staff is sent to a primary medical care partner to perform behavioral healthcare services, yet our staff is paid directly by the primary medical care provider and we are reimbursed for the use of our staff and services, are we covered?
Answer: You shouldn’t rely on the primary medical care provider’s policy to provide coverage to your organization because, more than likely, it won’t. It would not be unusual for both your organization and the primary medical care provider to be named in a lawsuit. You can expect your policy with Negley Associates to defend you.
Q10. If our staff is going to another contracted organization aren’t they covered under that organization’s insurance policy?
Answer: Not necessarily. The other organization’s insurance policy may not extend coverage to independent contractors. Coverage would also depend on the arrangements made with this other organization.
Q11. If we hire our own primary care physicians and they don’t have their own insurance doesn’t our current Professional Liability policy automatically provide coverage for them?
Answer: Not necessarily. Some insurance carriers won’t cover physicians that don’t have insurance. Other carriers will cover employed, but not contracted, physicians. And, many times, carriers do not provide automatic coverage but, instead, require that all physicians be listed by name on the policy. Negley Associates covers employed, contracted, volunteer, and/or temporary substituting physicians, whether or not they carry their own insurance, automatically.
Q12. If we hire our own primary care physicians and they have their own insurance then do they need to be covered under our policy?
Answer: Depending on the primary care physician’s policy wording, coverage may not extend to the physician while he or she is working on behalf of your organization. If this is the case, and you want to cover the physician under your policy, Negley Associates can provide this coverage.
Q13. If we hire our own primary care physicians and they have their own insurance then aren’t we covered under their policy?
Answer: A primary care physician’s policy will cover the individual physician but it will not provide coverage for your organization.
Q14. How will our policy change with regards to this exposure?
Answer: Negley Associates will affirmatively provide coverage in the policy wording and specifically define Primary Medical Care in the definitions section of our policies.
Q15. We have been providing certain primary medical care services to our existing clients for years. Haven’t we had coverage for this exposure all this time?
Answer: Depending on your policy’s wording, and the extent of primary medical care you are providing, you may or may not have coverage. Because more and more behavioral healthcare organizations are moving towards integration, and because it is expected that most carriers will not provide the coverage, we at Negley Associates feel it’s a prudent decision to affirmatively provide this coverage in the policy wording.
Q16. We don’t see any exclusion under our policy for primary medical care. Isn’t that enough?
Answer: No. Even if there is no exclusion, your policy’s definition of professional services may not extend to primary medical care. While it is anticipated that most carriers will exclude coverage for primary medical care, Negley Associates will affirmatively endorse your policy to provide the coverage.
Q17. Do most behavioral healthcare organizations’ current Professional Liability insurance protect them for primary medical care services now?
Answer: Because most PL policies written for behavioral healthcare organizations don’t contemplate protecting against primary medical care, current policy wording may not be adequate to cover the exposure. It is anticipated that many behavioral healthcare PL insurance carriers will not want to cover this exposure and most will specifically exclude it. Negley Associates recognizes the need for this coverage and will protect your organization for primary medical care.