Policyholder Services

I have been contacted by an online medical referral service to perform consultations for patients who have questions about their medical diagnoses or treatments. Will OMIC cover me for these activities?

In OMIC’s experience, online medical referral services typically submit to the consultant a summarized version of the patient’s medical information along with a list of the patient’s questions. The consultant reviews the materials, then provides the referral service with responses to each question posed. The consultant generally does not receive an actual or complete copy of the medical records, does not examine the patient, and does not have any direct contact with the patient. Communications between the parties are coordinated through the referral service.

Although the referral service would serve as the intermediary, you would be providing “direct patient treatment” by virtue of the medical opinions you render, and your OMIC policy would respond to a claim arising from these activities subject to OMIC’s standard policy provisions. Because services are rendered online rather than in person, it is possible, if not likely, that patients could reside in another state or even in another country. OMIC’s policy will respond only for claims filed within the 50 United States and District of Columbia, and only for services for which you hold a valid license. Most states require the physician to be licensed where care is delivered but may waive this requirement when consultations are not delivered “live.” Before rendering services, you should confirm with the applicable licensing board whether the patient’s state of residence requires that you be licensed in that state.

If you are considering conducting online consultations, either through a referral service or on your own web site, OMIC recommends that you contact one of our risk management specialists for confidential advice and assistance. They can guide you on your role as reviewing physician, what action to take if the information provided to you is incomplete or if the patient requires a physical exam or urgent treatment, and how to properly document your decision-making process and differential diagnosis, including the appropriate use of disclaimers.

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Publicly-traded insurance companies exist to make profits for shareholders while physician-owned carriers often return profits to their policyholders. Don’t underestimate this benefit; it can add up to tens of thousands of dollars over the course of your career. OMIC has one of the most generous dividend programs for ophthalmologists and has returned more than $20 Million to our members through dividends.