When life insurers have additional questions regarding an applicant’s health history, they may request this summary.
What is an Attending Physician Statement?
An attending physician statement (APS) is a written summary of your medical records detailing specific health conditions. Your insurer may request an APS when you apply for a life insurance policy. You must contact the physician or physicians who treated you for those health conditions if requested.
When do Life Insurers Require an APS?
Life insurers may request an Attending Physician Statement (APS) during the application process, depending on the type of policy you are applying for. If your application involves a health questionnaire or medical examination, insurers may seek additional information about your medical history or have follow-up questions based on exam results. This is when an APS becomes necessary.
The purpose of an APS is to obtain detailed information about your medical history and specific conditions from a healthcare provider who has treated you. For example, if you have conditions like diabetes or depression, the insurer may require an APS from your treating physician. This information helps the insurer assess your eligibility for coverage and determine appropriate life insurance rates.
An APS is a standard requirement in the life insurance underwriting process, particularly for senior applicants or those applying for substantial coverage amounts. It is also commonly needed if you apply for a waiver of premium rider, which allows your premiums to be paused if you become disabled.
How to Obtain an Attending Physician Statement
To obtain an attending physician statement (APS), you must typically approach your primary care physician or OB-GYN. In certain situations, the insurer may require an opinion from a specialist instead. Generally, the life insurance company requesting the APS will cover the associated costs.
Completing an APS usually takes around 21 calendar days, although some healthcare providers may require more time to prepare the statement.
Understanding the Attending Physician Statement (APS)
An Attending Physician Statement (APS) is your doctor’s comprehensive assessment of your health status from their professional perspective.
If any issues arise during a medical exam, the APS clarifies whether they stem from medication side effects or underlying medical conditions. Insurers require this clarity to precisely define a policy’s coverage scope.
If you have been treated for chronic conditions like asthma, diabetes, or sleep apnea, you might need to submit an APS.
Ordering an APS does not imply you’re ineligible for competitive insurance rates. Instead, it helps insurers accurately evaluate the health risks associated with your medical history.
Contents of an Attending Physician Statement
A standard APS typically includes:
- Condition History: Provide details on how long you’ve been treated, the onset of symptoms, treatment dates, and therapies attempted.
- Prognosis: Insights into how well you manage your condition and any improvements observed since treatment initiation.
If you receive treatment from multiple doctors for different conditions, insurers may request an APS from each relevant physician.
HIPAA and the APS
The Health Insurance Portability and Accountability Act (HIPAA) regulations govern APS disclosures. You must authorize your healthcare provider to share your medical history via a signed waiver with the insurer.
Insurers can only use APS information to assess your coverage eligibility and determine appropriate rates. They are prohibited from selling or divulging this sensitive medical information.
How Does an Attending Physician Statement Function?
An Attending Physician Statement (APS) is a detailed health report compiled by your doctor. The content of an APS varies based on the insurer’s requirements. Typically, insurers seek insights into your medical history, previous diagnoses, treatments, existing medical conditions, and potential symptoms of undiagnosed ailments. This may encompass both physical and mental health issues, such as:
- Cancer
- Heart disease
- Diabetes
- High blood pressure
- Sleep apnea
- Anxiety and depression
- Bipolar disorder
- Other mental health conditions
An APS strengthens your life insurance application, ensuring continuity of coverage. When your health details from the questionnaire, paramedical exam, and APS align, it significantly reduces the likelihood of your insurer denying claims related to death, critical illness, or disability.
Why Insurers Require an Attending Physician Statement for Your Medical History
Insurers request an Attending Physician Statement (APS) primarily to gain a thorough understanding of your medical background and current health status. This enables them to assess your insurance application and effectively manage their risks.
While insurance applications already collect basic health information from you, a medical professional’s input through an APS provides more detailed and professional documentation of your health and any existing medical conditions. They can identify issues you might not have noticed and provide insights into whether specific health markers are within normal ranges.
APSs become particularly crucial when dealing with complex illnesses such as cancer. They help insurers comprehend the nuances of your condition and how you and your healthcare provider have managed it over time. While paramedical exams offer some data on general health indicators, the professionals conducting these exams typically lack the expertise to address complex medical issues like physicians.
When Do Insurance Companies Request an Attending Physician Statement?
Insurance companies do not always request an Attending Physician Statement (APS). Most fully underwritten insurance policies do not require one. APSs are more commonly asked for more significant coverage amounts, as are elderly applicants or individuals with specific health concerns. Insurers generally prefer to avoid requesting APSs due to associated costs borne by the insurance company.
Insurance Products Requiring an Attending Physician Statement
Insurance products that may necessitate an APS include Life Insurance, Disability Insurance, Critical Illness Insurance, and Long-Term Care Insurance. However, APSs are not mandatory for every application. They are typically requested for scenarios involving substantial coverage amounts (e.g., several million dollars), documented health issues, or older applicants.
No Medical Life Insurance products, such as simplified and guaranteed issue life insurance, do not require an Attending Physician Statement as part of their application process.
Frequently Asked Question
What is an Attending Physician Statement (APS)?
An APS is a detailed medical report provided by your physician at the request of an insurance company. It summarizes your medical history, current health status, and treatments received. Insurers use this information to assess your life insurance eligibility and determine appropriate premiums.
When do insurers request an APS?
Insurers typically request an APS when additional medical information is needed beyond what is provided in the initial application or during a medical exam. This may be necessary for applicants with significant health issues, older applicants, or those applying for high coverage amounts.
What information does an APS include?
An APS includes details such as your medical diagnoses, treatment history, medications prescribed, any ongoing medical conditions, and the physician’s overall health assessment. It may also include information on specific health events or surgeries you have undergone.
Why do insurers need an APS?
Insurers require an APS to comprehensively understand your health status and medical history. This helps them accurately assess the risk you pose as an insured individual. APSs provide a deeper insight into potential health risks or conditions affecting your coverage.
Do all applicants need to provide an APS?
No, not all applicants are required to provide an APS. It is typically requested for applicants with complex medical histories, pre-existing conditions, older individuals, or those applying for large coverage amounts. Simplified issue or guaranteed issue life insurance products, which require less medical underwriting, may not necessitate an APS.
Conclusion
An Attending Physician Statement (APS) plays a crucial role in the life insurance underwriting process by providing insurers with detailed medical information about applicants. It helps insurers assess the health risks associated with insuring an individual, particularly for those with complex medical histories or applying for substantial coverage amounts. While not all applicants need to submit an APS, it is commonly requested to ensure that insurers thoroughly understand an applicant’s health status.