Life and Health insurers often require medical information and attending physician statements (APS) in order to underwrite insurance applications. As an insurance advisor I have received enquiries from ND’s asking about the role and responsibilities as physicians in regard to the APS and also about the process as an individual applying for insurance and giving consent for the release of medical information to the insurance provider.
Insurer’s Perspective
I will describe the insurer’s perspective on the information they require from a physician and explain how it is used in the underwriting process. To begin, the insurance advisor as well as the insurers make every effort to protect client confidentiality while respecting the client’s personal, financial and medical information. A request for medical information includes a signed consent form which allows the insurance company to share test results with the client’s physician. This will allow your patients to ask for the medical tests and lab results to be sent to their doctor of choice, at no cost to the patient. An insurer is under no obligation to offer this; however most are willing to provide this service. It is also common practice for the insurance company to advise the client’s physician of any abnormal test result found during the underwriting process, in hoping this will help physicians with the care of their patients.
Physician’s responsibilities
Medical information is collected by a third party service provider, and physicians are paid a reasonable fee for the service. (Fees paid may vary dependent on provider- current schedule “2013 Guide To Fees for uninsured services” an APS fee is $129.45).
Doctors requesting pre-payment must realize they are legally bound to provide the report immediately. The insurance company’s expectation is that an APS should be completed within 2 weeks. The service provider may request the information be faxed or mailed, and can provide physicians with information about the process. An effective way to complete a statement is to list the client’s problems and provide supporting documents of relevant test results. Example:
CHART
| Dates | History | Duration | Diagnosis | Tx, Rx, Procedures |
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Unless it is requested, you do not need to see your patient. If further information is required, you will be advised. If you feel you need to see your patient, for professional reasons, discuss this with the person asking for the report so that delays can be taken into account. It is important NDs recognize that failure to complete and offer full disclosure in these statements can have legal ramifications. Time too is a factor, as in the case of a doctor in Quebec who was charged with delaying medical evidence and on the client’s death was made responsible for the value of life insurance. With this in mind, a copy of the chart can be as good, if not better, than completing the written report. Physicians play an important role in the insurance application process.
Applying for insurance
What to expect during the underwriting process. There are a number of insurance tests that may be required. These services are covered by the insurance company.
- Paramedical exam: this is where a health professional will ask health history questions, and they will measure and record applicant’s blood pressure readings and pulse, height and weight and this can be done, at your home, place of work or a medical facility.
- A Medical Exam: a paramedical questionnaire and full physical exam conducted by a physician. This can be done as a mobile visit or at a fixed facility
- Blood profile: health professional collects a few vials of blood using a sterile lab kit, conditions tested : heart , live function, alcoholism, diabetes, kidney function
- Urinalysis- sample will be tested for nicotine use, drug use, HIV
- Resting ECG: can be done at home or office- records electrical activity of your heart
- Stress ECG: test is completed in a fixed facility, monitored by an internist or cardiologist
Insurance can provide peace of mind and financial security to protect you and your loved ones. The application process can take several weeks to complete. To reiterate, delays can be caused by incomplete questions on the application, unfulfilled medical requirements, incorrect contact information, the locating of physicians and medical reports, the forwarding of the APS in a timely manner and possible further medical testing.
I hope this article helps you when you are asked to complete an APS or when going through the process with applying for personal and business insurance.
Sindy Billan
Published in the BCNA Bulletin
The information in this article are presented for general knowledge and the content should not be relied upon as containing specific financial, insurance , tax or legal advice. Practitioners must seek their own independent professional advice to discuss their personal circumstances before implementing this type of arrangement.
E&OE/ 2014 SBILLAN Wealth Solutions doing Inc. business as SB Wealth Solutions
