Be cautious, turn around has been creeping into the 4-6 week window with many places. EOY is bad because they pull staff to get audit info together, May through July is also no picnic.
Problem with APS and Records
- Thread starter dabulls
- Start date
Be cautious, turn around has been creeping into the 4-6 week window with many places. EOY is bad because they pull staff to get audit info together, May through July is also no picnic.
- 4,132
Yea, they can drift off into never done land for sure.... I give them about 30 days and then sic the applicant on them to get the ball rolling. But you are right it can take much longer to get the info out of a doctor's office.
- 10,817
Technically if they go over 30 days it is a hippa violation. The carrier is requesting the records on behalf of the client. Any patient records request must be fulfilled within 30 days by hippa regs.
Of course many doctors/offices do not realize this or just do not care. And of course you dont want to strain the clients relationship with their doctor... but ive had some clients get extremely upset at their doctor over records request. Most of the time the doctor has no clue that his staff is dropping the ball.
I had one go up to 60 days. So I sent a letter certified mail to the doctor himself informing him of the situation and the fact that is was a hippa violation. I didnt use threatening language, just informed him of the situation. He called both me and the client personally to apologize. He also told us that "heads rolled" and he now has a new office manager. He was well aware that it was a hippa violation, and apparently my clients was not the only records request that was over 30 days.
- 15,041
I might have to try that. Getting records in less than 30 days is the exception in my experience. But you are exactly right, the doctor doesn't have a clue about it. The staff is the one that handles it. I always tell the applicant as soon as an APS is requested and I ask them to call the office and let them know and that they would appreciate it if the request were handled quickly.
- Thread starter
- #15
- 308
Wow that's good to know. I always wondered what would happen if the APS took lets say 60-90 days and your client died, let's say in a car accident on day 85. Would there be grounds for a lawsuit?
I know this is a very unlikely situation. The reason I ask this is my old trainer(ex Bankers) would always threaten the doctors office with lawsuits and what not lol
- 10,817
Im not a legal expert but it seems like there would be some type of liability there. If the client sent in conditional premium payment then the carrier would have to finish UW, if approved issue the policy, and pay the DB to the bene. So it wouldnt be an issue. But with no conditional premium then it seems the doctor would have some type of liability there if they went over the hippa 30 day limit.
I wouldnt threaten lawsuits. Id start with having the client call. Then escalate to sending the doctor a friendly letter certified mail informing them that they are past 30 days. Civility usually works better than threats... of course it was bankers your talking about so no surprise there... lol.
Also, some states have state laws that are less than 30 days. Some states have laws that are over 30 days (SC is 40), but the federal hippa law supersedes the sate laws that are over 30. But hippa does not supersede the state laws that are under 30.
- 8,707
But doesn't a conditional receipt run out?
- 10,817
Its carrier specific. With NA/Midland it lasts for 90 days after the date of the app.
- 26,089
I have used that to get records. I sent a copy to the medical director at Stanford, asked for the address to their legal counsel and let him know that in ten days a copy was going to the insured. They curriered the records to me 3 hours away.
I could learn a lot from your treachery lol
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