April 2018 - InsureYourCompany

It would be nice if your employer-provided health insurance offered blanket coverage that could pay for any medical appointment and procedure you needed. While it doesn’t generally work that way, many patients still find themselves surprised to be paying more than anticipated for the services they need.

If you’re struggling to understand why you’ve been handed a bigger-than-expected bill for services received at the doctor’s office, make sure you check out these five potential reasons.

Reason #1: Your Doctor Doesn’t Take Your Insurance

You took a recommendation from a friend or another doctor, and never thought to check whether or not your new provider would take your insurance. If they don’t, that may leave you responsible for the full amount of your visit.

It’s important to choose a doctor that takes your insurance before proceeding with service, since that can have a significant impact on your out-of-pocket payments.

Reason #2: You Didn’t Recheck for Coverage

You’ve recently visited a doctor that you haven’t seen in several years, and the bill was far higher than you expected. It looks like your insurance didn’t even touch it! If so, it may be that the office no longer takes your insurance or that they’ve changed tiers within your network and are no longer a preferred provider.

If you’re heading to the doctor for the first time in a while, always take the time to confirm that they still accept your insurance.

Reason #3: You’ve Gone to an Out-of-Network Provider

Your doctor may take your insurance, but that doesn’t mean that they’re a preferred provider for your insurance company. When you make an appointment with a new doctor or confirm an appointment with a doctor you haven’t seen in a while, it’s important to confirm that the practice is in the preferred tier for your insurance company.

While you may receive some coverage for out-of-network visits or for visits on lower tiers, it won’t be as comprehensive as you’d hoped, leaving you stuck with higher fees.

Reason #4: You Don’t Understand the Breakdown of Terms

There are several key terms that you need to understand when evaluating your health insurance policy. A stronger understanding of those terms will make it easier for you to understand what personal expenses you can expect when filing health insurance claims.

Copay: This is the amount you’re responsible for paying when you have medical expenses. This fixed amount is often collected by providers upfront.
Coinsurance: With coinsurance, you are responsible for paying for a percentage of your medical claim.
Deductible: Your deductible is the amount you must pay toward your personal medical expenses before your coverage kicks in.
Family vs. Individual: Often, you’ll have family deductibles and individual deductibles. A family deductible applies to the entire family as defined under your coverage, while individual deductibles apply to each member of the family. When you meet the family deductible in a calendar year, no other members of the family must meet their individual deductible in order to receive full coverage under your policy.

Reason #5: You Haven’t Updated Your Address

If you’ve moved recently and haven’t updated your address with your insurance company, it’s important that you do so as soon as possible! It’s not your employer or HR’s responsibility to keep up with your address change, and it’s not up to the insurance company to hunt you down.

When you update your address, you’ll receive EOB (explanation of benefits) notifications and new ID cards, which will make it easier for you to estimate the cost of future medical expenses.

Do you run a small business? If so, you know that every day, your company is at risk for potential lawsuits. That’s why is so critical that you have a general liability insurance policy.

Just about any type of business needs general liability insurance for covering medical costs and attorney’s fees resulting from property damage and bodily injuries. Here’s what you need to know about general liability insurance, including a few considerations and warnings.

General Liability Insurance and What It Covers

Maybe you’re not sure what’s meant by “general liability insurance.” This type of insurance—which is also known as business liability insurance or comprehensive commercial liability (CCL)—offers coverage for liability claims regarding bodily injury and other types of physical injuries or property damage that occur at your place of business.

This insurance policy goes into effect when a non-employee, or someone who doesn’t work for you, sues you. General liability insurance gives you protection from many of the common issues that can confront a small business, such as:

Costs linked with third-party bodily accidents and/or injuries to non-employees occurring at your business site, such as someone suing you because of a fall on your property, which led in a broken limb.
Damages to someone’s property. For example, you could be sued by your landlord because of a fire in your office that destroyed a portion of the building.
Lawsuits triggered from a business’s reputation being damaged. Let’s say you posted negative remarks about a competitor on social media. As a result, you could be sued for hurting their reputation. When you have general liability insurance, your insurance company can help in covering legal expenses, which include attorney’s fees and the cost of settlements.
Advertising mistakes or copyright infringement is also covered under general liability insurance. A common example is a competitor suing you because they think you copied their marketing or advertising materials.

Just as its name implies, general liability insurance policies are…well, general. This means they usually don’t involve specific types of risks that a small business can face—those may require their own separate policies.

Factors Determining the Amount of Coverage

The three main factors that determine how much coverage your business might need include:

The type of products your business manufactures. Of course, you’ll need more liability limits if your business produces dangerous products.
Perceived risk. When deciding on the amount of coverage you’ll need, think about how much risk is involved with operating your business. If you have a business that creates artwork or toys, you’ll need less coverage than, say, if your business produced heavy machinery.
The location of your business. If your business operates in a state known for rewarding higher damages, it’s a good idea to invest in higher liability limits.

Considerations and Warnings

General liability insurance covers your business for accidents that occur either at your business site or at your client’s place of business.
Coverage is included for legal teams representing your business, witness fees, and evidence costs, in addition to settlement or judgment fees for damages that you’re legally responsible for paying. It provides coverage for expenses involved in defending settlement fees, regardless of whether or not they’re fraudulent.
Because general liability insurance only gives you protection against certain kinds of claims, to fully insure your business, you also need to look into professional liability insurance, which is also referred to as errors and omission insurance.
It’s important to periodically review your general liability insurance policy at least every six months to see if you need to make upgrades or additions. Consider how your business can change, which means your insurance needs will probably need to change.

For all your business insurance needs, let our experts help. We work with a wide range of small businesses like yours to make sure they’re not only protected, but that they have the right information and education to succeed. Please contact us to learn more.

What makes an insurance agency special? For InsureYourCompany.com, it’s our people! That’s why we’re excited to launch our latest video series, Meet the Agent. Through these videos, you’ll be able to get to know our team members and what inspires them to bring affordable insurance and great customer service to clients like you!

First up: Dan Levenson, our director of marketing!

As the head of the marketing team, Dan is responsible for everything you’re looking at right now: our website, blog, and overall customer experience. Although his roots started in music—he still performs with a local community band—he was excited to join his family on the InsureYourCompany.com team.

For Dan, that family connection extends beyond his relatives in the office. He truly loves working with clients and helping them navigate the muddy waters of running a small business, whether it be on the phone or through the content published on the website.

Watch this video to learn more about Dan!

And if you enjoyed that video, check out our YouTube channel for more fun things to watch and learn!

Can an employee working remotely sue their employer under a state’s law against discrimination, even if the employee does not live or work in that state?

That’s exactly what happened in a recent case when a Massachusetts resident began working remotely for a company in New Jersey. She never lived in New Jersey and only visited the company’s headquarters a few times. She lived and worked from home in Massachusetts.

The Massachusetts resident claimed she was discriminated against and sued under New Jersey’s robust anti-discrimination law—even though she never lived or worked in New Jersey!

The court ruled that the Massachusetts resident could continue her case against the New Jersey company for discrimination under New Jersey law because she was an employee of a New Jersey company and “telecommuted” into New Jersey for work.[1]

What This Means for You

All companies, no matter how big or small, are at risk of being sued by an employee. Depending on your state, your company has up to a 40% chance of facing an employment practices lawsuit. When settlements are paid out, they average $125,000. [2]

If the case ends up in court, the median judgment is approximately $200,000, plus defense costs. 25% of cases result in a judgment of $500,000 or more.[3] Even if the case is baseless, it can still cost over $100,000 to defend.

Without Employment Practices Liability Insurance (EPLI), your business will pay these expenses out of pocket. A big claim can put your entire company at risk. With EPLI, however, all your company will pay is the deductible for a covered claim. Insurance covers the rest. If you have employees, you should have employment practices liability insurance.

About The Author

Michael Levenson has extensive experience working for insurance companies and in the health care field. Prior to joining InsureYourCompany.com, Michael was an attorney with one of the largest insurance defense firms in the country where he specialized in health care law and previously served as the judicial law clerk to a judge presiding in the New Jersey State Superior Court.

Mr. Levenson earned his Juris Doctor degree from Albany Law School with honors. While in law school, he served as a Constitutional Law Teaching Fellow and worked at Albany Law School’s Civil Rights and Disabilities Law Clinic, where he dealt with a myriad of health care law issues.

[1] Trevejo v. Legal Cost Control, Inc., N.J. Super. App. Div., 2018
[2] 2015 Hiscox Insurance Employee Charge Trends Across the United States
[3] Ibid.

A medical office has a number of moving parts that all need to be protected, and the pressure to keep up with them all can make anyone overwhelmed. Just one error can mean a loss of reputation or funds that you’re probably not ready to face this year (or the years to follow for that matter).

But there’s no reason to despair if you’re worried that your office may not be stacking up in terms of the total safety package. There are plenty of steps you can take, both big and small, to get a better handle on protection.

If you’re a dentist, doctor, physical therapist, or physician’s assistant who wants to tighten up the reins on their office, it’s time to consider what true protection really means.

Compliance

From HIPAA to OSHA, the rules for medical offices continue to become more stringent—especially when it comes to potentially harmful medical situations.

For example, any employees exposed to blood-borne pathogens during the course of their shift are entitled to a Hepatitis B shot free of charge. While it’s unlikely that an employee will catch this dreaded disease, they may be able to sue you for any and all repercussions if they do happen to catch it. If the office is audited for safety practices, you may face fines if you’re found to be violating any of the rules.

Instead of adding drama to every scenario (because let’s face it, medical offices are bound to see their fair share of communicable diseases), medical offices can focus on introducing better policies that both protect patients and employees without sacrificing on efficiency. This may include hiring more staff members or designating one (very organized) person to stay on top of everything. It could also just mean becoming more aware of the biggest risks in the office before making a game plan on how to deal with them.

Cyber Security

It’s clear that criminals are no longer solely targeting credit card numbers when it comes to data theft. Medical fraud continues to skyrocket and, by some estimates, eats up as much as 10% of all healthcare spending.

With this much money on the line, the federal government continues to introduce more chances to HIPAA and HITECH laws, and their standards become ever stricter when it comes to how offices safeguard their patient’s data.

Because technology changes so quickly, many of HIPAA and HITECH’s general rules have to do with taking “reasonable” precautions to protect data. While these types of phrases are ultimately deciphered by a judge in the case of legal battles, medical offices may want to look into measures that will keep them out of legal hot water in the first place.

For example, encryption is one way to make sensitive patient information unreadable—even if a thief does manage to crack your system. In other words, firewalls and perimeter protections may not nearly be enough to keep a motivated cyber thief at bay. The good news is that as encryption becomes more popular, it also becomes cheaper and easier to implement.

Important Insurance Coverages

Even the safest offices in the country will still face situations that they could never have prevented. The right commercial insurance will be available to medical offices when they need it the most, and it can take everything from direct costs to the costs of rebuilding a tarnished reputation. Doing more to protect your office can reduce your chances of ever needing to use your insurance immensely, but it can’t take care of everything.

The first step you can take is to research the limits of your current policy as well the exact kinds of coverage you have. For example, if a patient decides to sue you for pain and suffering, or if the government fines your office for failing to keep up with modern safety practices.

Learning more about how your insurance will respond to specific risks is a smart way to prepare yourself if the worst occurs. Having a backup plan that you can count on not only makes it easier to pay for everything, it also makes all of your responsibilities much easier to face.

Additional Measures

Better protection isn’t about buying a product or having a few seminars in the office. Those steps would be easy, fast, and relatively painless. What protection really boils down to is an attitude the owners and leaders take toward everyone involved in their organization.

Whether an office has 20 patients or 200, there are plenty of ways to increase your protection. Putting additional resources into safety, updating or changing your insurance policies, and researching new protection methods are all long-term steps you can take toward a more successful (and more profitable) practice.

When you’re picking a pet, you probably consider a number of questions: Will it shed? What—and how much—will it eat? Will it bark (tweet, chirp, howl, meow)? Will it smell bad?

There’s one more question that should be on this list, but all too often isn’t: Will a pet affect my homeowner’s insurance rates?

Read on to discover which animal pals can impact your homeowner’s policy.

Pets and Your Homeowner’s Policy

For many pet owners, that furry (or feathery, or scaly) friend is simply a member of the family. For a home insurer, however, pets may represent a potential liability. According to the Insurance Information Institute, dog bites and other dog-related injuries account for more than a third of all payouts on homeowner’s policies. The average cost of these payouts is a whopping $33,000 per bite. Together, pet-related payout costs total more than $600 million per year—a cost that has risen by more than 94 percent since 2003.

These incidents aren’t all about bites. Fractures and injuries may occur when dogs knock down others, such as children, the elderly, or bicyclists. Given the high costs of such incidents, it’s not hard to see why home insurance providers must look at pets in an objective manner.

Pet liability is a common issue, as a majority of American households do have pets. According to the 2017-2018 APPA National Pet Owners Survey, 68 percent of American households include pets. Of these, 60 percent own dogs and 47 percent own cats. Fish, birds, reptiles, and other small animals are among the next most commonly owned pets. Not surprisingly, most pet-related claims have to do with dogs.

Dogs and Homeowner’s Insurance

Homeowner’s insurance often covers pet-related injuries, but insurers may make decisions about pets and coverage based on dog breeds, and your dog’s breed may affect the type and price of a homeowner’s insurance policy.

While some insurers may make coverage decisions on a case-by-case, pet-by-pet basis, other insurers may determine coverage based on statistics related to the average number of bites reported for specific breeds. These numbers may change based on breed popularity and geographic distribution, but certain breeds tend to be on the list year after year, including:

Doberman pinschers
Great Danes
Pit bulls
Rottweilers
Staffordshire terriers

Laws vary from state to state, as well. In some states, dog owners are liable for any injuries caused by a bite if they were aware their dog’s breed had a propensity to bite, while in other areas, certain dog breeds are listed as dangerous on “breed-specific statutes” that identify certain breeds as dangerous. Some states require owners of certain dog breeds to take out insurance, while other states don’t allow insurers to deny coverage to dog owners.

Regulations are complex, and insurers must take all these factors into account when making coverage decisions for pet owners.

So, what’s a dog owner to do? Start by researching breeds before you bring a new pet home. You can talk to breeders, veterinarians, and trainers to get a professional opinion on which types of pet will work best for your specific situation. Take steps to socialize and train your dog to prevent the need for claims in the first place. Keep track of your research and document the steps you’ve taken to ensure a safe home for your dog and others.

Exotic Pets

While dogs are, by far, the most common pet to impact homeowner’s insurance, what if your tastes run a little more…exotic?

If you’re the proud owner of, say, a snake, pot-bellied pig, or big game cat, you still need to ensure that your insurance provides the right coverage. In some cases, wild animals or other exotic pets aren’t covered under typical homeowner’s policies. In such cases, you may want to consider exotic pet coverage that will offer appropriate coverage. Just keep in mind that if any pet poses a high liability risk, coverage will likely cost more.

In all cases, the key lies in being honest with your insurance provider. It’s better to be up-front, especially if an incident happens and you need to file a claim. Talk to your insurance agent about your options; they’ll help you find the right coverage for your unique situation.