Insights
Buying and renewing coverage
How to shop it, what moves your premium, and what to settle before you cancel anything.
What moves the number
Seven things decide what you pay
Premium is not a quote for a building. It is a read on what happens inside your practice, who does it, and what has already gone wrong somewhere like it.
What you perform
The service list drives the class. Adding one procedure can move a practice into a different underwriting box entirely, which is why an undeclared service is the most expensive thing in a file.
Who performs it
Physician, NP, PA, RN, aesthetician. The credential matters, and so does the supervision structure behind it.
How supervision is documented
Not whether you have a medical director. Whether the chart shows the relationship working the way the state requires.
Claims and incidents
Loss runs, open matters, and anything reported but not yet a claim. Volunteering an incident costs less than having it surface later.
Limits and structure
Per claim, aggregate, who shares the aggregate, and whether the form is claims made or occurrence.
Your state
Scope of practice, corporate practice of medicine, and the local litigation climate all sit in the number.
What you bill
Revenue by service line is how an underwriter sizes the exposure rather than the practice. Two practices performing the same procedures at different volumes are not the same risk.
Before you shop
Have these five things ready
Every market asks for the same material. Assembling it once turns a three week exercise into a one week one, and a complete submission reads better than a thin one.
The submission pack
- A current service list, written as what you actually do rather than what the website says.
- A provider roster with credentials, license numbers and start dates.
- Your supervision and delegation protocols, as they exist in writing today.
- Five years of loss runs from the current and prior carriers.
- Revenue split by service line, which is how an underwriter sizes the exposure rather than the practice.
Shopping it
Three agents in one market is not three quotes
Most specialty medical markets clear submissions on a first in basis. The first agent to reach a market with your name on a submission holds it. A second agent sending the same risk to the same market is blocked, and the market now has two files that disagree.
The practical effect is that spreading a submission across several agents narrows your options rather than widening them. It also tells every underwriter who sees it that the account is being shopped hard, which is not a neutral signal.
If you want a second opinion, ask for it by market rather than by agent. A good agent will tell you which markets they are approaching before they approach them, and will not object to being held to that list.
Before you cancel
Two dates, and they are not the same date
The date a policy ends and t