An Attending Physician Statement (APS) is a detailed medical report issued by a healthcare provider who has treated or is currently treating an insurance applicant. This document is a fundamental tool used by life insurance companies during the underwriting process to gather a comprehensive summary of an applicant’s medical history. The APS helps the insurer assess the risk associated with offering coverage and ultimately determine the appropriate policy and premium.
The Medical Data Included in an APS
The content of an APS is specifically focused on delivering a targeted extract of an applicant’s medical file that is relevant to risk assessment. It often contains sensitive patient health information (PHI) that adheres to privacy regulations like HIPAA. This report provides a verified, professional perspective on the applicant’s health.
The statement typically includes a detailed history of past and current diagnoses, noting when conditions began and how long treatment has been ongoing. It outlines the specific treatment plans prescribed, including surgical procedures or ongoing therapies. The APS also provides a comprehensive list of all prescribed medications, including dosages and the dates they were taken, which offers a clear picture of medication compliance.
The APS also includes laboratory results, imaging reports, and the physician’s clinical notes from patient visits. The document provides a prognosis, which is the doctor’s outlook on the management of existing conditions and the patient’s expected long-term health.
The Logistics of Obtaining an APS
The process of obtaining an APS is initiated by the insurance company after an applicant has submitted their application and signed the necessary authorization forms. Because the APS contains protected health information, the applicant must sign a specific HIPAA-compliant medical release form. The insurer then sends a formal request to the physician’s office or hospital that has treated the applicant.
The physician’s office is responsible for compiling the report from the applicant’s medical records and sending it directly to the insurance carrier. This is often the most time-consuming part of the underwriting process, as physicians prioritize patient care over administrative paperwork. The time required can vary significantly, often taking several weeks or even a few months in complex cases.
The insurance company typically covers the cost associated with preparing and transmitting the APS, as it is a required part of their due diligence for risk evaluation. If an applicant has seen multiple specialists, the insurer may request an APS from each attending physician. This multi-step process is the primary reason why the underwriting timeline can extend for a long period.
How Underwriters Use the APS for Risk Assessment
Underwriters use the information in the APS to translate an applicant’s health history into an actuarial risk score, which determines the final cost of the policy. The underwriter’s primary role is to evaluate the severity and stability of any reported medical conditions against the company’s established mortality tables. They look for consistency between the applicant’s self-reported health information and the documented medical facts.
Specific findings within the APS, such as the date of a cancer diagnosis or the control level of a chronic condition like diabetes, are important for assigning a risk classification. Underwriters analyze the treatment history to ensure the applicant has been compliant with physician recommendations and medication protocols. Evidence of well-managed, chronic health issues may result in a more favorable rating than a newly diagnosed or poorly controlled condition.
The underwriter uses the APS to place the applicant into a specific risk category, which ranges from Preferred Plus, receiving the lowest premiums, to Standard, or Substandard, which carries higher rates. For example, a history of well-treated hypertension with documented compliance to medication and normal lab results will be assessed differently than unmanaged hypertension with recent concerning cardiac findings. If the medical information indicates a risk level that exceeds the company’s threshold, the application may be declined entirely.