What is an attending physicians statement?
Any applicant or member of a health plan must provide the insurance company written approval to obtain medical records. This written approval is part of the original health insurance application and new applicants will not be accepted as a member without providing this authorization. There are two times when an insurance company may request an attending physician’s statement: during a new enrollment application process and during a claims eligibility review. The new enrollment application process entails the completion of a health questionnaire that is used by the insurance company to determine the risk of the insurance company in accepting the applicant as a plan member. The insurance company may request medical records to verify the truthfulness of these statements or obtain additional details about a specific medical condition or concern. Not all new applicants will have their medical records reviewed at the time of the application because the insurance company has the authority to review records at a later date. If a plan member submits a claim to the insurance company, the insurance company may review medical records to determine if that claim applies to any pre-existing medical condition waiting periods or if that claim pertains to a medical condition that was knowingly withheld from the insurance company on the health questionnaire. The information obtained on the attending physician’s statement will determine if the insurance company is liable to pay the claim. 1 CommentLeave a comment |
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What is an attending physicians statement?
More commonly known as “medical records,” an attending physician’s statement is often required by an insurance company to review the medical history of a new applicant or an existing plan member. An attending physician’s statement can be requested from a doctor, hospital or any other health care provider. If the applicant or plan member has a primary physician, the statement will be requested from this doctor because he has complete records available to him and will have information in the patient’s files from referrals to specialists and lab and radiology reports. An attending physician’s statement will include the reasons for office visits, the results of that visit, any prescribed medications, lab reports, lifestyle concerns, weight, blood pressure and recommendations made to the patient by the attending physician. The doctor may also make notes of his observations and concerns, even if these concerns are not discussed with the patient.
I don’t know if this is the right place to post this, but I have a question about Medicare plans that I would like you answer. I recently moved to Texas to retire and now I have found that physicians actually refuse to accept Medicare as payment! I thought this had to be a joke at first, but apparently it’s not. I worked for 20 years at a large corporation that offered a very good insurance package and maybe I have been spoiled, but the corporation makes all retirees go on Medicare. So naturally I was surprised that physicians could deny Medicare plans. What is going on? How can they deny Medicare? What am I supposed to do? Go across town to find one who accepts?
Comment by Robert — June 21, 2009 @ 10:43 am