Breaking Away Into Your New Practice and Common Insurance Issues

Let me talk for a moment about clarifying insurance issues.

If you are already employed within a hospital or medical group or within another medical setting and planning to breakaway, be sure to understand the existing arrangements that you may have with third party reimbursement carriers.

For example, are you in network and bound by the existing insurance contracts as a participating physician?

Do those contracts apply to you?

Do they require that the insurance company concent before you bill outside and breakaway?

Are you bound to submit all claims no matter what they’re origin through the insurer, even if they’re delivered offsite or in a new practice?

Do the contracts follow you personally, do they follow your NPI or do they follow your employer?

Do you need permission from your employer to breakaway?

Sometimes we suggest the clients write the insurance company or head of department announcing the plans to create a new practice, well asserted in the letter that the physician is not bound in the new practice by existing arrangements with the employer. We ask the insurer to write within 30 days if it disputes this assertion. In the absence of a reply we would argue that silence equals acceptance.

On a separate note, for your own practice, please look into professional liability insurance, premises liability insurance, general umbrella liability coverage and cyber liability coverage for HIPAA and data breach issues. Make sure that any professional liability insurance also covers your integrative anti-aging or functional medicine practices.

Please let us know if you have any questions related to this area.