Reporting Adverse Events is a Double-Edged Sword

Stacy Tait, MD, FACC

To the Editor

As David Hunt mentioned in the Summer 2003 issue of the APSF Newsletter, his group suffered by following APSF and medical insurance companies’ recommendations to report any untoward event. We have had a similar experience. Our insurance company gave us about 40 days notice that they were going to terminate our coverage, based on claims history. We reported several untoward events to them as we had been instructed to do in our insurance-sponsored classes to reduce litigation exposure.
Based on several nuisance suits (everyone named even though there was no anesthesia mishap) and those self-reported untoward events, we were considered too risky.

We appealed the decision and won, but had to apply to other carriers in the meantime. We decided to drop our insurance carrier because of a 250% increase in our premium quote with them and because of the way they handled the situation which imposed great stress on our group.

We have a new carrier. They were glad we reported any untoward events because once reported, the carrier is liable for coverage and damages. Now our premium is much less, and our benefits much greater. Our new carrier provides unlimited legal defense for HIPAA and Medicare investigations, and they also pay government/ HIPAA fines up to the limits of the policy. Our previous insurer only paid $25,000 of legal fees in these circumstances, and our current insurer pays up to $50,000 in legal defense. Neither picks up the fines.

In the end, we are glad it happened. We have a better and cheaper product. Reporting untoward events is a double-edged sword and may not be as benign as the insurance companies would have one believe. We have heard of horror stories of Medicare investigations and feel safer now that we are with a new carrier.

Stacy Tait, MD, FACC
Fort Smith, AR