An Attending Physician Statement (APS) is a formal medical report requested by an insurance company when an applicant seeks coverage. It is typically sought for life insurance or long-term disability benefits. The APS provides a medical summary to clarify an applicant’s health status beyond the information provided on the initial application or through a standard paramedical exam.
The Role of the APS in Underwriting
Insurance companies rely on the APS to accurately assess the risk associated with insuring an applicant. Underwriters use this statement to verify or clarify any medical information the applicant has already disclosed, especially concerning pre-existing conditions or recent medical events. The document helps confirm past diagnoses, treatment dates, and the overall stability of any health issues. This verification process is instrumental in determining insurability and establishing the appropriate risk classification for the policy. A detailed medical history allows the insurer to set a fair premium rate that reflects the applicant’s current health status and anticipated future risk.
Information Included in the Statement
The content of an APS summarizes the applicant’s medical record. The attending physician provides specific data points detailing the history of the patient’s health, including dates of initial diagnosis, frequency of follow-up visits, and the duration of the patient-physician relationship. The statement also includes objective medical evidence, such as laboratory test results, imaging reports, and physical examination findings. Details about prescribed treatment plans are documented, including current and past medications and their dosages. Finally, the physician often provides a prognosis, which assesses the patient’s likely course of recovery and compliance with the medical regimen.
The Process of Obtaining the APS
The procedure for obtaining an APS begins with the applicant granting the insurance company permission to access their medical records. Applicants must sign a specific authorization, often a Health Insurance Portability and Accountability Act (HIPAA) release, allowing the insurer to initiate the request. The responsibility then shifts to the insurance company, which sends the formal request directly to the physician or medical facility.
The insurance carrier is typically responsible for covering the administrative cost associated with preparing the statement, not the applicant. This fee compensates the medical office for the time and resources needed to compile the extensive documentation. The length of time required to receive the APS can be the most significant delay in the entire underwriting process, often taking several weeks or even months. Because preparing the APS is not a direct patient care activity, it is often prioritized lower by busy medical offices, which can extend the time before the insurer can finalize the coverage decision.