Question
Connecticut:
I am an insurance agent and my client is being denied Long-term care insurance because his doctor ignors repeated requests by the insurance underwriter, his patient, and me to send the required attending physician's statement to the insurance company. The insurance company will pay for the reports but the doctor's staff says the doctor still has not even acknowledged the initial request after over two months of requests, and they can do nothing until he approves the request.
My client is trying to protect several hundred thousand dollars of assets from exposure to the possibility of nursing home expenses.
What can my client do to obtain a copy of his three year medical history from this primary care doctor so it can be sent to the insurance company?
Answer
I used to deal with this very end of things in a medical practice. You need to get past the red tape. It is not likely that the physician's office is ignoring this request intentionally, their practice simply may not be organized or staffed properly enough.
1st thing I would do is get the patient to request his medical records (This will ordinarily get done quicker than an APS). He must present a HIPAA compliant request and all requests have to be responded to in writing. At least he can get these records to supplement the APS.
Second, have the patient contact his doctor's nurse, directly....have him explain his situation and ask her if he can stop in personally with the papers to have them signed. I would be sure the patient fully completes all sections that he can, ie name, etc, and sign it. Often patients drop off forms with no name, etc and expect the nurses, doctors to just figure out what diagnosis he/she is claiming disability, etc for. It's not always clear in patients who have multiple health issues. Also, this APS will need to have a HIPAA compliant authorization form as well. While all physicians may not be aware of this, his office may have stalled the process due to lack of authorization.
Also, there may be an administrative fee involved. Unless the medical documentation is for continuity of care or subpoenaed, the medical office can stall the process if the patient has not pre-paid, etc. I would call to find out their policies on that.
Good Luck--I'd be curious to know your outcome, send a re-post of your results!!