Telehealth Clinicians Warned of Malpractice Coverage Gaps as Patients Travel

Homewood Insurance Group, a Naples-based specialty insurance broker, has issued a warning to telehealth clinicians about the potential gaps in their malpractice coverage as patients travel for the winter. The company emphasizes that clinicians must hold a license in the state where the patient is located during the telehealth visit, not where the clinician is based or where the patient resides.

Homewood Insurance Group highlights that a routine telehealth follow-up can cross state lines, potentially leaving the visit outside the clinician's license and malpractice coverage. The principle is straightforward: a clinician must be licensed in the state where the patient is located during the visit, not where the patient lives or where the clinician's office is. For instance, a patient wintering in Florida or a student back at college can change the state where the care takes place for the duration of the call.

Insurers follow the same logic, rating telemedicine malpractice policies based on the patient's location rather than the clinician's office. Each state a clinician serves must be listed on the application. Cross-state care without licensure often leads to outright denial of coverage. Traditional malpractice policies, written for in-person care, often exclude or restrict remote encounters, patients located in another state, or electronic prescribing. Some carriers limit coverage to video visits, although advice given by phone, secure message, or patient portal is also considered telemedicine with the same failure-to-diagnose exposure.

The company recommends that clinicians who see patients remotely take several steps to ensure adequate coverage: 1. Ask where the patient is at the start of every remote visit and record it in the note. 2. Hold a license in each state where patients actually are. For physicians, licensure through the Interstate Medical Licensure Compact is viewed favorably by underwriters. 3. List every state served on the malpractice application. 4. Ask the carrier, in writing, which remote activities are covered, in which states, and at what limits, and confirm that audio-only and asynchronous encounters are named. 5. Read any telehealth platform's policy and insure separately the work done outside it.

Homewood Insurance Group notes that the cost of securing appropriate coverage is rarely high. Because remote encounters are usually lower-acuity, telemedicine is often rated at or below the provider's in-person specialty. Current 2026 market data puts annual premiums at $375 to $3,000 for nurse practitioners and physician assistants, $2,000 to $6,000 for a provider or startup, and $5,000 to $25,000 for a specialty physician. High-risk lines such as teleradiology, telepsychiatry, and opioid e-prescribing in litigious states run $20,000 to $35,000.

Homewood Insurance Group advises that the cost of securing appropriate coverage is rarely high, with premiums ranging from $375 to $3,000 for nurse practitioners and physician assistants, $2,000 to $6,000 for a provider or startup, and $5,000 to $25,000 for a specialty physician. High-risk lines such as teleradiology, telepsychiatry, and opioid e-prescribing in litigious states run $20,000 to $35,000.