What you need to know about insuring a Spa

  What  you  need  to  know  about  insuring  a  Spa         The International Spa Association defines spas as "places devoted to enhancing overal...
Author: Gabriel Hensley
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What  you  need  to  know  about  insuring  a  Spa      

  The International Spa Association defines spas as "places devoted to enhancing overall well-being through a variety of professional services that encourage the renewal of mind, body and spirit.” There are currently an estimated 20,744 spas operating in the United States. In 2013, the Spa Industry brought in over $14 billion dollars which consisted of over 160 million spa visits. Guide to the different types of Spas: Day Spa A day spa offers spa treatments exclusively on a day-use basis. Many also offer salon services. Size and character can vary widely. The important thing here is to find out if the day spa is separated from the noisier salon environment. Destination Spa A destination spas sole purpose is to help you lead a healthier lifestyle through spa treatments, exercise, and educational programming. You stay at least two nights. Some have minimum stays of three or seven nights. Spa cuisine is served exclusively. Resort/Hotel Spa A resort/hotel spa is located within a resort or hotel. It offers spa services, fitness classes and spa cuisine alongside less health choices like steaks and burgers. It's a good choice when one person wants spa and the other golf. It also works for business travelers and families. Medical Spa A medial spa offers treatments that require a doctor's supervision, such as laser resurfacing and Botox injections. It also offers spa treatments. Mineral Springs Spa A mineral springs spa has natural mineral, thermal or seawater that is used in hydrotherapy treatments. Club Spa A club spa is a day spa located in a fitness facility or health club.


Medical Spas Medical Spas are a unique business. They merge the medical industry with the beauty/spa world to provide always evolving anti-aging and cosmetic services. As a multi-billion dollar industry, doctors are realizing more and more that these cashed based businesses are a fast, easy way to boost their income and eliminate the headache of having to deal with insurance companies. Medical spas' menus of services vary widely and depend greatly on the Medical Director or owner's experience. Core services include: Microdermabrasions Microdermabrasion is a non-chemical, non-invasive procedure that uses a spray of microcrystals to remove the outermost layer of dry, dead skin cells and reveal younger, healthier-looking skin. Microdermabrasion also encourages the production of a new underlying layer of skin cells with higher levels of collagen and elastin, which further improves your skin’s appearance. Chemical Peels A Chemical peels is when a chemical solution is applied to the skin, which makes it "blister" and eventually peel off. The new skin is usually smoother and less wrinkled than the old skin. Laser Hair Removal Laser hair removal is a medical procedure that uses a laser — an intense, pulsating beam of light — to remove unwanted hair. During laser hair removal, a laser beam passes through the skin to an individual hair follicle. The intense heat of the laser damages the hair follicle, which inhibits future hair growth. Intense Pulse Light (IPL’s) Intense pulsed light, commonly abbreviated as IPL, is a technology used by cosmetic and medical practitioners to perform various skin treatments for aesthetic and therapeutic uses including hair removal, photorejuvenation, and treatment of dermatologic diseases. Botox

Botox  is  a  drug  made  from  a  neurotoxin  produced  by  the  bacterium  Clostridium  botulinum  called  botulinum  toxin. It is used cosmetically to remove wrinkles by temporarily paralyzing muscles. Dermal Fillers Dermal fillers, also know as injectable cosmetic filler or injectable facial filler, is a soft tissue filler injected into the skin to help fill in facial wrinkles, restoring a smoother appearance. VelaShape VelaShape was the first non-surgical FDA cleared medical device for body reshaping and cellulite treatment. It treats both the deeper tissue and upper layers of the skin. LipoSelection LipoSelection is a form of liposuction that uses ultrasonic energy in a deliberate controlled fashion to assist the doctor in the selective removal of fat in body contouring surgery.


Laser Body Sculpting Laser Body Sculpting rapidly dissolves fat and tightens the surrounding skin almost anywhere in the body. Using local anesthesia, the procedure is performed with a small one-millimeter cannula that contains a laser fiber. The laser fiber delivers energy directly to the fat cells causing them to rupture and drain away as liquid. Tattoo Removal Tattoo removal is most commonly performed using lasers that break down the ink particles in the tattoo. The broken-down ink is then absorbed by the body, mimicking the natural fading that time or sun exposure would create. All tattoo pigments have specific light absorption spectra. A tattoo laser must be capable of emitting adequate energy within the given absorption spectrum of the pigment to provide an effective treatment. Sclerotherapy Sclerotherapy effectively treats varicose and spider veins. It's often considered the treatment of choice for small varicose veins. Sclerotherapy involves injecting a solution directly into the vein. The sclerotherapy solution causes the vein to scar and collapse, forcing blood to reroute through healthier veins. The collapsed vein is reabsorbed into local tissue and eventually fades. After sclerotherapy, treated veins tend to fade within a few weeks, although occasionally it may take up to a month to see the full results. Platelet Rich Plasma Platelet Rich Plasma, or also known as “PRP” is an injection treatment whereby a person’s own blood is used. A fraction of blood (20cc-55cc) is drawn up from the individual patient into a syringe. This is a relatively small amount compared to blood donation which removes 500cc. The blood is spun down in a special centrifuge (according to standard Harvest Techniques) to separate its components (Red Blood Cells, Platelet Rich Plasma, and Plasma. The platelet rich plasma is first separated then activated with a small amount of calcium to allow the release of growth factors from the platelets which in turn amplifies the healing process. PRP is then injected into the area to be treated. Platelets are very small cells in your blood that are involved in the clotting process. When PRP is injected into the damaged area it causes a mild inflammation that triggers the healing cascade. As the platelets organize in the clot they release a number of enzymes to promote healing and tissue responses including attracting stem cells to repair the damaged area. As a result new collagen begins to develop. As the collagen matures it begins to shrink causing the tightening and strengthening of the damaged area. When treating injured or sun and time damaged tissue they can induce a remodeling of the tissue to a healthier and younger state. The full procedure takes approximately 45 minutes - 1 hr. Generally 2-3 treatments are advised, however, more may be indicated for some individuals. Touch up treatment may be done once a year after the initial group of treatments to boost and maintain the results.   Mesotherapy     Mesotherapy treatment is a non surgical cosmetic solution aimed at diminishing problem areas in your body such as cellulite, excess weight, body contouring, and face/neck rejuvenation. It is administered via numerous injections containing various types of FDA approved medicines, vitamins, and minerals. It is introduced into the mesoderm, the layer of fat and tissue underneath the skin. The content mixture of the injection varies in accordance with each unique case and specific area to be treated. Mesotherapy can also assist in reducing pain, and in replenishing hair loss in both men and women. HCG HCG is an extreme diet that involves injections of HCG (human chorionic gonadotropin). HCG is the hormone women make when they are pregnant. Previously, the HCG Diet was defined by a 500-calorie diet paired with daily injections of HCG. Now the diet ranges from 500 – 1,500 calories per day depending upon the patient. Patients general lose one to two pounds per day while one the diet. HCG keeps you from losing muscle while losing weight.


Who can work in a Medical Spa besides a Physician?

Licensed esthetician (LE)

Physician's assistant (PA)

Nurse practitioner (ARNP, FNP) Nurse (RN, LPN)

Medical Assistant (CMA)

Licensed  Esthetician  (LE)   Esthetics comes from the Greek word aesthētikos, which means to have an appreciation of beauty. An esthetician is a person who is professionally interested in the health and beauty of our body's largest organ, the skin. Licensed estheticians (LE) are trained skin professionals who have a passion for learning elemental details about the inner workings of the skin. Estheticians study anatomy and physiology, skin analysis, cosmetic chemistry, cosmetic ingredient formulations, various treatment modalities including laser and light therapies, how to prepare and care for skin undergoing deep resurfacing or other surgical procedures; as well as hair removal, massage techniques and makeup artistry skills. Job Responsibilities -Esthetician in a Clinical Setting For licensed estheticians working within a clinical setting, such as cosmetic surgery, outpatient clinic, hospital, laser center, medical spa or dermatology, job responsibilities encompass a variety of duties. A well-trained and experienced esthetician will help manage pre- and post-operative skin care and makeup needs, as well as provide a liaison between doctor and patient. The role of the esthetician within a medical practice is an important one. As directed by the physician, the esthetician can reinforce home care protocols and the proper usage of medications and help provide education to the patient. The esthetician may also serve as a surgical consultant, help develop a relationship with each patient and answer questions about procedures and communicate realistic expectations. Estheticians are often a patient's first point of contact, as many times a patient will see an esthetician for services prior to seeing the physician. Since many skin diseases and abnormalities require medical care, it is important that the esthetician is familiar with recognizing, but not diagnosing, the difference between a potentially serious lesion requiring medical attention or one with caution abnormalities. A typical day includes skin care consultations and analysis, assessing each patient's personal skin care goals and recommending a plan of action to reach those goals. If the plan includes surgery or laser resurfacing, the esthetician will outline proper pre- and post-treatment care to help the patient attain optimal skin health prior to surgery and to prepare


the skin for post-procedure healing. This may include a series of microdermabrasion treatments, chemical peel treatments or deep cleansing facials prior to surgery, followed by skin soothing facials after surgery. She will also document the patient's progress with before and after pictures and record treatment notes in each patient's chart. Often in a physician's office that has an attached medical spa, an esthetician will manage and run the product retail center, taking responsibility for choosing and selling product lines that best suit patient needs. In addition, the esthetician will provide makeup consultation services for post-procedure camouflage, if necessary. In a medical spa environment, under a physician or nurse practitioner supervision, a licensed esthetician may provide laser therapies, depending on the state regulations, such as laser hair removal, vascular-spider vein or intense pulsed light treatments (for wrinkles and pigment), and even endermology treatments (machine massage for cellulite). Nurse (RN, LPN), Medical Assistant (CMA) While not a requirement to obtain employment within a medical practice, employment opportunities are increased for the licensed esthetician if her medical education includes medical assisting or a nursing degree. At the same time, medical assistants or nurses who desire to work in a medical spa, cosmetic surgery or dermatology environment would benefit from obtaining licensure in esthetics in order to thoroughly understand the complexities of the skin. Some medical assistants may be trained on the job. However, to obtain certification in medical assisting (CMA), one must graduate from a specific trade school or junior college and pass a nationally standardized test to become certified. The usual course is about eight months long. Medical assistants study human anatomy; physiology and pathology; medical terminology; administrative duties; laboratory techniques; clinical and diagnostic procedures; pharmacology; medication administration; first aid; office practices; patient relations; medical law and ethics. They complete a practical clinical externship within a physician office. CMAs may be trained to administer injections and assist in surgery, including surface suturing. The two nursing positions discussed here-Registered Nurse (RN) and Licensed Practical Nurse (LPN)sound similar, but there are substantial differences in educational requirements and job responsibilities. LPN training programs last approximately one year and include classroom study and supervised clinical practice. The majority of LPNs train at a technical or vocational school. All 50 states require that LPNs pass a licensing examination, and licenses must be renewed. Many states also require continuing education requirements for licensing renewal. These types of nurses may not give injections, sclerotherapy or Botox. The requirements to become a Registered Nurse (RN) are more demanding than for the LPN. All 50 states require that Registered Nurse candidates obtain a nursing degree from an approved nursing program. There are three educational opportunities to a nursing degree: a Bachelor of Science degree in nursing (BSN), an associate degree in nursing (ADN) and a diploma. A Bachelor of Science degree in nursing is typically a four-year program. An associate degree in nursing is typically offered by community and junior colleges and takes about two to three years to complete. A diploma program is also offered in hospitals that that typically lasts about three years, but this type of program opportunity has declined in recent years. There is also now a doctorate given in nursing, although nurses with these degrees usually remain as fulltime instructors at nursing schools. Job Responsibilities-Nurse and Medical Assistant Daily responsibilities of the medical assistant in a clinical setting will vary from office to office. In smaller practices, medical assistants wear many hats, from performing administrative duties, such as answering phones, greeting patients, handling insurance forms and other correspondence, to clinical duties including taking medical histories, recording vital signs, explaining treatment procedures to patients, preparing patients for examination and assisting the physician during the examination. Medical assistants also instruct patients about medication and special diets, prepare and administer medications as directed by a physician, authorize drug refills as directed, draw blood, remove sutures and change dressings. Nurses working in an out-patient facility will prepare for and assist with examinations, assist in diagnosing and treating common illnesses and injuries, administer medications and injections, dress wounds, assist with minor surgeries and maintain health records. They cannot prescribe prescription medications. In a medical spa, cosmetic surgery or dermatology office, medical assistants and nurses must understand and be familiar with medical skin care and peel therapies, medical facials and medical spa therapies. The MA or RN will also assess the patient's skin type and conditions; recommend skin care treatment options; administer injectables such as sclerotherapy, Botox, and other dermal fillers; assist in surgeries; and perform facial protocols, microdermabrasions, chemical peels, and laser therapies.


We Have the Answers to Your Questions About Your Spa

Q: Can I insure my Medical Director on my current Medical Spa Insurance policy to perform treatments in my clinic? A: Yes, Medical Directors offering either administrative duties only or direct patient care services can be covered by the clinic's Medical Spa Insurance policy. Q: If my Medical Director is insured on the medical spa policy, and we have a claim, does that affect the Medical Director’s individual Medical Malpractice policy? A: No, our medical spa insurance programs are set-up to defend and pay-out up to the policy limits for any covered claim that the may occur. Therefore, the medical director's individual medical malpractice policy should not be affected. There can some exceptions. Q: Can You provide Medical Spa Insurance coverage in all 50 States? A: Yes, we can write directly in all the States with a number of competitive Medical Spa Insurance companies. Q: Can I add additional procedures to my current Medical Spa Insurance policy? A: Yes, but the insurance companies will want to know about the new procedures prior to offering to the general public. Q: Can I add additional Aesthetic clinics to my current Medical Spa Insurance policy? A: Yes, however the insurance companies will want to know a head of time and an additional premium may be required. Q: Is there a minimum premium for Aesthetic/Medical Spa Insurance? A: Our carriers have programs that start at $1,500 annually. However, premiums are typically based on the procedures being offered and the number of procedures being performed. Q: Can my staff be covered under my Medical Spa Insurance policy? A: Yes, however the insurance companies typically ask to receive copies of training completion to confirm that the staff has been property trained on the procedures. Q: Can you help me with my Equipment Insurance and General Liability Insurance coverage? A: Yes, our carries have competitive programs to provide both Equipment Insurance and General Liability Insurance coverage. Coverage can also be extended to an off site location if you attend a trade show or perform treatments at another facility/clinic. Q: I just received a subpoena or letter of intent to sue. What should I do? A: If you have been contacted in regard to a lawsuit, or you suspect that you may be contacted in the future, it is important to contact your carrier immediately, so that they can proceed in your defense, if necessary. make no attempt to contact the patient or the patient's attorney to discuss the subpoena or any other paperwork you may receive. And please, avoid the temptation to talk with your friends and colleagues about the subpoena. It is important that your insurance provider is the first person in which you discuss the details of the subpoena. Q: Are the insurance requirements for a "day spa" different from those for a "med spa"? A: Since a med spa incorporates procedures and services that most States consider the “practice of medicine”, a qualified physician must be involved. Professional liability coverage must cover your spa, the clinicians performing the procedures and the physician in his/her role. Q: Must the physician associated with the medical spa be a Plastic Surgeon or Dermatologist? A: No. However, the physician must be qualified to supervise those performing the procedures. Q: Isn’t the easiest way for a physician to cover his medical spa-related work to secure a rider from his present malpractice carrier? A: No. Most insurers do not offer these types of riders. Q: Are there any required liability limits? A: For professional liability (malpractice) coverage, the typical liability limits are $1,000,000 per occurrence and $3,000,000 in aggregate. This will vary, however, depending on the carrier and State in which the spa operates. Q: What is required to procure coverage and how long is the process? A: We have a two page spa application that needs to be completed to obtain quotes. Typical turn around time is 24 hours.


Day Spas

Day spas are a place you go for the day to get massage, facials, and body treatments, like sea salt scrubs and mud wraps. Many day spas combine both a hair salon and spa. It usually started out as a successful salon and added spa services. A day spa with salon services often has manicures and pedicures. Tranquil settings, robes and slippers, clean linens, professional products and healthy lunches and teas are all part of the perfect experience at a day spa. Day Spa Menu: Facials A facial is one of the best ways to take care of your skin, especially when it's given by an experienced, knowledgeable esthetician. A facial cleans, exfoliates and nourishes the skin, promoting a clear, well-hydrated complexion, and can help your skin look younger. A facial is the second most popular spa treatment after a massage. Massages A massage is the rubbing and kneading of muscles and joints of the body with the hands, especially to relieve tension or pain. The most common is the Swedish massage, which is a whole-body therapeutic massage designed to relax the muscles and joints. Other popular types include deep tissue, shiatsu, hot stone, reflexology, and Thai massage. Manicures A manicure is a cosmetic treatment of the hands involving cutting, shaping, and often painting of the nails, removal of the cuticles, and softening of the skin Pedicures A pedicure is the same thing as a manicure except on your feet. Waxing Waxing is to cover or treat an area of the body with wax typically to remove unwanted hair. Hair Services Hair services generally include cut, color and/or styling. Makeup Application Makeup application is the art of applying makeup to the face and body.


What  types  of  coverage’s  are  available  for  Spas?   •

Medical Professional Liability (Claims Made) Professional liability or “malpractice” coverage is possibly the most important, least understood, and may likely be the most expensive component of your insurance program. Simply put, professional liability coverage insures against injuries caused by your performing or failure to perform your professional services. Injuries could include burns from a laser or chemical  peel, allergic reactions to skin preparations, muscle injuries from a massage, or an infection at an injection site (etc.). The list of potential causes of a professional liability claim is endless.

Medical General Liability (Occurrence or Claims Made) General liability coverage is often sold as a package policy with property coverage. Whether sold as a package or a stand-alone policy, the coverage is the same. General liability coverage protects against lawsuits arising out of the operation of your business. Policies normally include trip and fall accidents, product liability, allegations that your business has committed libel, slander, and trademark infringement, and fire legal liability. Fire (or tenant’s) legal liability coverage protects you against lawsuits arising out of damage caused by your business to the premises rented to you. For example, this would cover damage to building from a fire caused by unattended candles in the spa. General liability policies normally exclude intentional acts (like assaulting a customer), professional liability (malpractice), and workers’ compensation.

Property Coverage Property insurance coverage will include your “business personal property” (partition walls for treatment rooms, floor and wall coverings, laser equipment, etc.) and your building (if you’re the owner). Coverage varies from policy to policy but will ordinarily insure against all perils except those that are specifically not covered. Many property insurance policies also include a host of coverage enhancements such as coverage for theft of money, back-up of sewers and drains, glass and signs, and business interruption coverage. Business interruption insurance protects against loss of business income resulting from a covered loss at your location such as fire. Coverage normally includes ongoing expenses, payroll, and loss of net income. When purchasing property insurance, opt for “special form” coverage (side bar). The policy should also provide coverage on a “replacement cost” basis. Replacement cost policies pay claims based on the actual cost to replace the damaged or destroyed property without deducting depreciation.

Defense of Licensing Coverage Defense of licensing coverage will reimburse you for the cost of your defense if you are the subject of an investigation by a state licensing board.

Defense Outside the Limit Defense Outside the Limits means that your primary limit of liability will not be eroded by defense costs or claim expenses. Defense costs are provided in addition to your primary limit.

HIPAA Liability HIPAA is the federal Health Insurance Portability and Accountability Act of 1996. The primary goal of the law is to make it easier for people to keep health insurance, protect the confidentiality and security of healthcare information and help the healthcare industry control administrative costs. HIPAA Liability provides coverage for violations of the law.

Independent Contractors Liability Insurance Independent Contractor Liability Insurance, provides protection for independent contractors against potential liability for claims arising from clients. In order for a claim to be successful the client would need to prove that the contractor has been negligent.


Medical Director Coverage Medical Director Coverage can include for Administrative Duties, Supervisory Duties, Good Faith Exams, or Direct Patient Care Administrative Duties: The medical director participates in administrative decision making and recommends and approves policies and procedures. They meet regularly with the administrator or decision maker and provides leadership needed to achieve medical care goals. Supervisory Duties: The medical director supervises employees or independent contractors including chart sign off but does not have direct patient contact. Good Faith Exams: Certain states require that a good faith exam is performed prior to a procedure being done. The good faith exam is a brief meeting wherein the medical director may assesses the patient, makes note of their medical history, and explain the procedure prior to the first treatment. Thereafter, no further exams are required and those properly licensed medical professionals may then administer future treatments.  Not  all  states  require  good  faith  exams.   Direct Patient Care: The medical director works directly with the patient and performs the actual procedure(s).

Privacy and Security Liability Privacy and Security Liability provides coverage for financial loss, penalties, and defense costs due to cyber threats and data loss. Coverage often includes lost or stolen portable devices, computer hacking, employee misuse, negligent release of data (i.e. social security numbers) and improper disposal of paper documents or computer equipment.

Sexual Misconduct Liability Sexual Misconduct Liability provides coverage for loss payments and claims expenses with regards to any claim arising out of any sexual misconduct, sexual abuse/molestation and/or child abuse/molestation.

Employment Practices Liability   Employment Practices Liability provides coverage for wrongful termination, sexual harassment, discrimination, invasion of privacy, false imprisonment, breach of contract, emotional distress, and wage and hour law violations.


  Who to contact about my spa: Clifton  Insurance  Agency,  Inc   http://cliftoninsuranceagency.com/medical-­‐spa-­‐malpractice-­‐insurance.htm     Office:  877-­‐212-­‐4368     Fax:  806-­‐457-­‐1760     Email:  [email protected]