You would think that in this age of technology and the fact that laptops are used in most doctors’ offices today, the retrieval of an Attending Physicians Statement (APS) would be lickety-split. The truth is this process is still antiquated and if we, the Brokerage General Agency (BGA), do not know the medical history from the inception of the application process, the ordering of an APS can be delayed.
Case in point: Today we have both express apps and drop ticket applications. Neither requires the agent to get any medical information in advance. The application and medical information is done via phone interview. Once that is completed, the carrier may take three to five working days to review and then make a request for an APS. The APS is ordered by the BGA, through that carrier’s approved service provider, typically that same day. This is where the fun starts!
4/19—Request for an APS is made.
4/19—Service provider faxes request to the doctor’s office.
4/20—Call made to see if the request was received; had to leave message requesting callback to confirm receipt. Re-faxed request to ensure receipt.
4/25—Medical Records clerk for the doctor’s office verified that the request was not yet received and that they had a preferred fax number. Re-faxed request.
4/26—Called medical records area of doctor’s office to verify receipt of faxed request. Voicemail states to allow two to three days to verify request was received. Left message and requested callback to confirm receipt.
4/28—Receipt of request confirmed! Doctor’s medical records clerk advised that the turnaround time for an APS is 15 days to be copied. Once copied they will fax an invoice for payment, once paid they will release the records.
5/2—Follow up on invoice. Not released yet.
5/4—Follow up on invoice. No invoice generated yet.
5/5—Follow up on invoice. No invoice yet.
5/8—No invoice as of today. Called doctor’s office medical records area and was advised that they process APS copies in order of receipt and have not gotten to this APS yet.
5/10—Follow up on invoice. No invoice yet.
I could go on but I think you see my point. Making matters even worse, many medical facilities, including hospitals and doctors’ offices, now utilize copy services for getting medical records sent out. These copy services are merely processors and have not a care about getting the records out in a timely manner. They simply put the request in a queue. There is no sense of urgency no matter how hard we push!
HIPPA is also making the process harder. Some facilities do not accept the HIPPA forms provided by the insurance companies as part of their application packets, causing delays, and/or do not accept electronic signatures, causing delays.
There are actually state laws under HIPAA1 directing how long a medical facility or doctor’s office has for release of medical records. In the state of Texas, a hospital must make a patient’s recorded health care information available to the patient no later than 15 business days after receiving a written authorization. This may sound good; however, there is no recourse if they go beyond the 15 days leaving a state law that is violated. Even with this, as in our example above, the copy service gives themselves three days just to verify the authorization was received!
This is still an antiquated process. As a BGA we have tried several methods of speeding this process along including:
- Picking up the APS if the facility is in our vicinity.
- Asking the client to push their doctor in getting the records sent out.
- Asking the client to retrieve their records.
- Sending a letter to the doctor’s office letting them know they will be liable if they delay the process of our mutual client getting life insurance and the client passes away.
As a producer you can help too:
- If your client is a woman, make sure you have her correct name and maiden name—records may be in both.
- If you know there may be an APS required on your client due to their medical history, ask your client to wet sign a HIPPA Authorization even if you are dropping a ticket.
- Prepare your client for the medical history interview. They will need to know their own history such as doctor or facility names, addresses and the time frames regarding visits.
There is a silver lining. If you have been to the doctor’s office lately, most have laptops right in the examination room and are updating your records electronically. Electronic health records2 are coming of age and will make the retrieval of medical records almost instantaneous. Several records vendors are in the trial stage, and we may see them going live by the end of this year. Electronic APS services will eliminate copy services and immensely reduce the life application cycle time.
In the meantime, know your BGA is doing all they can to get the medical records to the carrier for a speedy decision on your client’s life insurance benefits. Although we can’t move mountains, we do try.
Reference:
- http://www.healthinfolaw.org/comparative-analysis/individual-access-medical-records-50-state-comparison.
- https://www.healthit.gov/providers-professionals/frequently-asked-questions/334#id2.
