Our helpline is a differentiator for ProAssurance because the Risk Management team is available to agent partners and insureds five days a week, 8:00 a.m. – 5:00 p.m. local time. They can call us with something as simple as a quick question or as in depth as a research assignment. It is a tool that gives our customers access to an entire team of professionals. That is what differentiates us.
This service is important because it is a measure of our customer service standard and demonstrates one of our collective successes. The Risk team has tangible numbers to demonstrate the difference we are making: "How many calls are we getting?" "How fast are we responding to customers?" "How quickly are we able to pick up the phone and answer the question?" It is not a generic voicemail box or an unmonitored inbox. It is truly monitored in real time.
Responding to calls helps our team stay connected and keep a pulse on pressing topics. We are not the ones in the offices or practicing the medicine, so it is a glimpse into what’s going on day-to-day with our insureds. With the helpline, our department stays current on trends and, with help from our data team, we can synthesize information and identify where we can provide added resources.
Who answers the helpline?
The Risk Management department is composed of lawyers, clinicians, risk managers, and practice managers. If the call representative cannot answer your question, we have a team that will get you that answer as quickly as possible.
The Risk Management team may also be the first point of contact for a potential claim. Our staff triages unexpected outcomes, such as procedures that do not go as planned. Sometimes we are the first person an insured calls after a bad outcome. Our team can involve the claims department to preserve coverage. Callers may have concerns and feel alone in their situation, and our role is to listen and provide practical guidance in an exceedingly difficult moment.
Looking at the Big Picture
As you explore the cases we’ve shared here, remember this: behind every case is a Risk Management Consultant building a relationship with an insured while they work together to overcome difficult, scary, strange, or even just everyday challenges.
Tales from Helpline Veterans
Relationship Building on the Helpline
A particularly poignant example of relationship building on the Helpline is a heart-wrenching story about a young doctor who became seriously ill himself and was struggling to treat his patients. The Risk Consultant noted that it is not uncommon in a small practice that the physician does not have a practice manager, and often the physician’s spouse takes on the administrative role. That was what occurred in this situation.
“He’s the only provider in a small town and had no one to transition his patients’ care to. His biggest concern was making sure his patients received the care they needed; that they were taken care of. Brad and I had a conference call with the doctor and his wife that was very emotional. His wife was really the only one who could try to figure out what to do with the patients. She had no idea where to begin so we made a plan prioritizing the steps she needed to take to safely and according to state laws notify patients and begin the process of closing his practice. It was a very difficult situation. Totally overwhelming, in addition to having to deal with the sudden illness of her husband.” This consultant stays in contact, sometimes calling her just to check in and see how she’s doing.
Navigating Complex Ethical Dilemmas
“I was contacted by an in-vitro fertilization (IVF) clinic with a unique situation. A lesbian couple, both of whom are deaf, requested that donor sperm from a deaf man be used for their IVF treatment to increase the chances of conceiving a deaf child. This request presented a complex ethical dilemma. On one hand, intentionally facilitating the birth of a child with a legally recognized disability might place physicians in a challenging position from a medical ethics standpoint. On the other hand, is it discriminatory to deny such a request? In researching this issue, I found a surprising amount of academic literature on the topic. Many individuals who are hard of hearing do not consider themselves disabled. Instead, they view their condition as a ‘non-traditional’ lifestyle and often prefer that their family aligns with that lifestyle when possible.”
When Online Dating and Patient Care Collide
“There was a call from a concerned doctor. He had matched with a current patient through an online dating website. The doctor did not pursue the match, but the matched patient scheduled an appointment with the doctor specifically at his practice. The doctor had already told the patient he did not want to pursue the match, and he called our helpline as he was now concerned about his ongoing treatment relationship with the patient and his obligations to that individual in light of the uncomfortable circumstances. Our general advice was to terminate the patient from the practice to avoid any accusation of an improper relationship as there had been an obvious breakdown in the physician-patient relationship.”
Competing Interests and Patient Privacy
“Another interesting call was from a mother who wanted medical records from her deceased adult daughter’s ob-gyn practice. This was complicated because HIPAA privacy survives the death of a patient, meaning a practice cannot hand over medical records to just anyone. The risk management advice to the practice was to determine the patient’s marital status at death to see who the proper personal representative may have been and if there was an estate. It was discovered the patient’s mother needed the medical records as she was the listed beneficiary on the deceased patient’s life insurance policy. The complicating factor was that the deceased patient had been newly married, and there was concern over who should receive the death benefits—the mother or the new spouse. Our team was able to advise the practice what documents to review, what questions to ask of the parties involved, and options of how to handle the request. Ultimately in this situation, the practice was not necessarily required to provide the medical records, so our team was able to help prevent a HIPAA breach.”
The Impact of State and Federal Law on Risk Management
“I was on a call with a doctor who wanted to report the HIV+ status directly to the partner of a pregnant patient (the baby’s father) who the patient had not yet told she is HIV+. I shared with the doctor the relevant portions of the Texas Health and Safety Code and an email with my recommendations and the options available focusing on doing what the doctor thought was ethically correct. In the email I identified the Department of Health Services and their partner program as a disclosure option as well the option to not disclose. I feel like I helped the doctor prevent a HIPAA breach and maintain the provider-patient relationship while doing what the doctor thought was ethically correct.”
Mourning an Insured and Helping a Daughter in Need
“A young woman called the helpline. When I answered, she said she was calling on behalf of her father, our insured, who passed away the night before. She was looking for information on closing his practice and what all was needed to close his insurance policy with us. Of course she was tearful, so I spent a few minutes to allow her to catch her breath, share my sympathies, and provide information to her in bitesize pieces. When I looked up her father’s policy, the first thing I noticed was that two days later, three days after his death, was his birthday. We discussed the ups and downs of losing a parent so close to another milestone day. Allowing her to share stories and the hardships she was facing in the next few days was very satisfying for her. I was able to also give her the information about closing his practice and was able to notify Underwriting for her about her father’s death. When you pick up a call, you don’t know what the issue is on the other side, but this day, I was glad to have answered and mourn a man I never met with a daughter I never met.”
Compassion and Advice for a Young Surgeon after an Unexpected Outcome
“I can honestly say that the calls that touch me the most and where I feel the most valued are the calls from physicians after an unexpected outcome where their patient suffered harm. They are experiencing many emotions including shock, frustration, fright, self-deprecation, and, most of all, concern for their patient. Although I have taken many such calls through the years, I specifically remember a call from a young surgeon whose patient suffered a complication during a procedure. I spent over an hour on the phone listening to the physician. Of course, we talked about risk management actions such as talking to the family and documentation. I also brought in a Claims Specialist at the end of our conversation to further assist the physician. However, what I remember most is that I simply listened as he talked and tried to reassure him when I could. Even though in the physician’s opinion he was not negligent, it still greatly affected him, and he was devastated. He even mentioned that he was not sure if he could continue practicing. He thanked me and said that he felt better after our call. I’m not sure if he was just saying that to be nice, but I hope it was true.”
Duty to Warn vs. HIPAA After Patient Brandishes a Gun
“I once took a call from a distraught therapist who was threatened with a gun. During a counseling session, the therapist’s patient brandished her police officer husband’s service revolver that she had taken from an unsecured gun safe while he was sleeping. The patient threatened the therapist, and while she was able to talk the patient into putting the gun away, she felt that the patient posed a threat to herself, the therapist, and possibly to others. The therapist made the requisite report to the practice but wanted to know if she could call the police, or was she bound by confidentiality. I was able to confirm that “Duty to Warn” supersedes HIPAA and she should report the event to law enforcement and to the husband who should know what his wife had done. I double-checked state law for any nuance and was able to advise the therapist appropriately.”
Mother of Patient Tips Doctor in Cash, What Now?
“I know I have had several memorable calls but sometimes the details fade over time. I distinctly recall one where the mother of a 19 -year-old patient with an eating disorder slipped cash into the pocket of the doctor’s coat and would not take it back. They tried to issue a refund; I think because they wanted it to be correctly recorded in their system. The doctor was worried about the fact that the parents were interfering with the patient following the court’s orders and whether they had a duty to report to anyone. In a way, there was no real resolution other than they were not required to report anything to anyone, as the patient was 19 and it was not their responsibility to assure compliance with the court orders.”
Employee & Patients in Embezzling Scheme. Termination: Yes or No?
“I recently took a call where one of the insured’s employees is accused of and being investigated for committing embezzlement against the practice. Several of her relatives are patients who they believe are also involved in the scheme. The practice wanted to know if they can discharge the relatives as patients. The police did get involved, and I told the healthcare professional they can discharge the patients but still need to provide information on how to get medical records and details like that. That was kind of a unusual one.”
There is no limit to the type of calls the ProAssurance Risk Management department can and will address on behalf of our insureds. If you have a question you would like to discuss with a Risk Management Consultant, email RiskAdvisor@ProAssurance.com or call 844-223-9648.