The Attending Physician Statement (APS) is a specialized form of medical documentation prepared by a treating physician for a third party. It functions as a formal report on a patient’s health status. The APS is required in financial and legal contexts where a person’s medical history impacts a decision, such as insurance underwriting or claims. Unlike a patient’s chart, the APS is a dedicated summary requested to provide clarity and expert opinion on specific health matters.
Defining the Attending Physician Statement
The Attending Physician Statement is a concise, narrative summary prepared by the physician who has been treating a patient. This report is commissioned by an outside entity, most often an insurance company, to gather precise details about a patient’s medical background. It serves as a focused extract of comprehensive medical records, designed to answer targeted questions the third party needs to assess risk or a claim.
Unlike a raw Electronic Health Record (EHR), which contains unstructured daily notes, test results, and correspondence, the APS requires the doctor to interpret the clinical data. The treating physician synthesizes this information to provide a professional assessment and opinion.
Content and Scope of the APS
The information included in an APS focuses heavily on the clinical course of any reported condition, going beyond basic patient demographics. Physicians are asked to state the precise diagnosis, often using diagnostic codes, and specify the date when the patient first experienced symptoms or received treatment. The report details the complete treatment regimen, including all prescribed medications and any physical or psychological therapies.
Specific sections detail the patient’s functional capacity, outlining any physical or cognitive limitations that may affect daily activities or employment. The physician is also asked to provide a prognosis, which is the expected course and outcome of the condition, and an estimated date of recovery or return to work. To support these conclusions, the APS typically requires the inclusion of objective medical evidence, such as diagnostic test results, laboratory findings, or imaging reports.
The Request and Authorization Process
The process for obtaining an Attending Physician Statement is initiated by the requesting entity, such as a claims adjuster or insurance underwriter. Due to privacy regulations, patient authorization is mandatory. The patient must sign a specific, often time-limited, authorization form that permits the release of their protected health information to the third party.
Once the insurer has the signed release, they send the formal request and the proprietary APS questionnaire directly to the physician’s office. The requesting entity is responsible for covering the administrative fee, which compensates the medical practice for the time required to review records and generate the detailed report. This fee can be around $350. The time required to receive a completed APS varies significantly, sometimes taking several months depending on the volume of requests and the provider’s efficiency.
Primary Uses of the APS in Financial Decisions
The Attending Physician Statement is a mandatory document in two primary financial decision-making processes, directly linking a person’s health history to their financial security. For life insurance, the APS is used during the underwriting process to determine the applicant’s level of risk. Underwriters analyze the medical details to accurately assess the applicant’s life expectancy and subsequently determine eligibility and the correct premium rate.
The document is also heavily relied upon in both short-term and long-term disability claims. The information provided by the physician establishes the severity of the illness or injury, the resulting functional impairment, and the expected duration of the disability. This professional assessment is used by the claims department to validate the claim and authorize the payment of benefits.