Texas Nurse Practitioner Telehealth Malpractice Insurance Across State Lines (What to Check Before You Click “Join”)
- Jeff Schmidt
- Oct 8
- 3 min read
Telehealth is here to stay—and plenty of Texas NPs now see patients in multiple states from a single clinic day. The question is whether your malpractice insurance (and contracts) are set up for the way you actually practice.
Start with the three non-negotiables
1) Licensing & scope, per state. Hold the appropriate license/registration in the patient’s location and keep scope within that state’s rules (collaboration, prescribing, supervision).
2) Policy territory and “where coverage applies. ”Many NP policies cover you where you’re licensed and legally practicing, but the fine print matters. Confirm that out-of-state telehealth may be covered and whether any states are excluded.
3) Contracts that quietly set the bar.Hospital telehealth panels, payer agreements, and staffing addenda often dictate minimum limits (commonly $1,000,000 / $3,000,000) and sometimes specify claims-made + tail vs. occurrence. Match the policy to the highest bar you must meet.
Claims-made vs. occurrence for telehealth
Occurrence: Cleanest for multi-state practice—no tail after you leave a platform or client.
Claims-made: Works fine if you manage the retro date and plan for tail when contracts end (especially if your telehealth platform won’t provide it).
The Texas angle: practical realities
Texas doesn’t impose a statewide NP malpractice mandate, but credentialing norms do. As you add telehealth states, the highest contract requirement tends to win. If one platform wants $1M/$3M occurrence and another accepts $500k/$1M claims-made with tail, set your own policy to satisfy the strictest so you can say “yes” to more opportunities with less re-work.
Common cross-state patterns (and how to stay covered)
TX home base → FL side panel
Ensure your policy lists territory broad enough for both TX and FL and confirms telehealth is within scope.
If FL patients include autonomous practice scenarios, double-check proof requirements and keep your dec page ready.
TX → compact of states/platform mix
Keep a simple record: states served, license numbers, first date of service. It helps if you ever need to evidence where the incident occurred.
If claims-made, verify new states don’t reset your retro date.
TX + PRN urgent care shifts
Employer’s policy may cover only employed shifts. A personal NP policy can provide continuity across telehealth plus PRN—handy if you toggle between W-2 and 1099.
The “Before You Click Join” checklist
□ Licenses active for every patient state.
□ Policy territory includes those states and telehealth services.
□ Limits meet the highest contract requirement (often $1M/$3M).
□ Policy type matches expectations (claims-made with tail plan, or occurrence).
□ Dec page saved as PDF; if claims-made, note retro date.
□ BAA/Privacy endorsements if you’re handling PHI with third-party tools.
□ Moonlighting and multiple settings explicitly allowed, if relevant.
What to send credentialing when asked for “proof”
Your Declarations Page with named insured, limits, dates, and policy type.
If claims-made: a line noting your retro date and, if requested, an attestation that you will purchase tail upon termination.
If a platform requires a specific form, attach your dec page and paste your policy details into their form fields verbatim.
Our practical take
If you expect to mix platforms or expand states, consider occurrence for simplicity. If you prefer claims-made, just treat tail as part of the project cost when you exit. Either way, size limits to the strictest contract so you don’t have to re-shop mid-credentialing.
Ready when you are:
Disclaimer: Sample guidance only—coverage, availability, and pricing are always underwritten and may vary by carrier and risk factors.
