Record Requests/Lien Inquiries

Frequently asked questions:

Insurance Record Requests

Do I need to include a notarized HIPAA authorization form?

All Record Requests made by a law firm, attorney, or representative must include a notarized HIPAA authorization form. Fidelis Care requires the authorization form to be notarized in order to protect our member’s privacy.

All Record Requests made by a member to have records sent to a third party must include a HIPAA authorization form. Please note, Record Requests made by a member do not require the HIPAA authorization form to be notarized.

Do I need an original HIPAA authorization form to complete a request for records?

No. A copy is acceptable as long as it is compliant, notarized and legible.

What happens if my HIPAA authorization form is not compliant or notarized?

Fidelis Care will not process the request and will notify you in writing indicating the reason your request could not be processed.

Can I follow up on my request via email, phone or fax?

No. Fidelis Care will not process any requests or provide any updates via email, phone or fax. All requests and follow up MUST be sent in writing to:

Fidelis Care
Attn: Legal Affairs
95-25 Queens Boulevard
Rego Park, NY 11374

Does Fidelis Care provide medical records? If not, who do I contact for medical records?

Fidelis Care is a health insurance company and does not generally have medical records. Please contact the health care provider that rendered the services for medical records.

How long should I wait before following up on a request?

The entire process can take up to 30 days to process. If you have not received your records within this time frame, please follow up in writing via USPS or overnight courier. Please include a self-addressed stamped envelope in order to permit Fidelis Care to respond.

Liens and Subrogation

Is Fidelis Care part of an ERISA plan?

No.

If a member receives Medicaid through Fidelis Care, and Fidelis Care is not asserting a lien, does that mean that Medicaid will also not assert a lien?

Fidelis Care can only waive its own lien. You (the member) need to query Medicaid directly regarding its liens.

Will Fidelis Care assert a lien for personal injury cases?

Fidelis Care does not assert liens for the personal injury cases of Medicaid managed care members, but documentation proving it is a personal injury matter must be provided to Fidelis in order to receive a lien waiver letter. Fidelis Care may assert a lien for personal injury cases of Medicare members.

Will Fidelis Care assert a lien if my case involves workers’ compensation or no-fault injury?

Yes. Fidelis Care asserts liens against no-fault, workers’ compensation and/or other third-party health insurance claims through Fidelis Care's outside vendors. Inquiries should be mailed directly to:

Fidelis Care
Attn: Legal Affairs
95-25 Queens Blvd 
Rego Park, NY 11374

What documentation do I need to submit for a lien waiver?

If Fidelis Care does not assert a lien, Fidelis Care will accept any one of the following documents in order to provide a lien waiver for a personal injury case:

  • Summons & Complaint
  • Bill of Particulars
  • Claim acknowledgement form from an insurance carrier, provided the type of policy is described
  • A letter from a third-party insurance carrier if the type of policy is described
  • Executed retainer agreement (the type of accident must be mentioned in the agreement)
  • Executed settlement agreement 

Where can correspondence regarding liens and/or subrogation be sent?

All correspondence regarding liens and/or subrogation must be sent to:

Fidelis Care
Attn: Legal Affairs
95-25 Queens Boulevard
Rego Park, NY 11374

May I fax or email correspondence or documentation to Fidelis Care?

No. Fidelis Care will not accept any documentation by fax or email. All documentation must be submitted to the aforementioned address.

If I have questions regarding liens and/or subrogation, who should I contact?

Any inquiries regarding liens and/or subrogation should be submitted to Fidelis Care in writing to the aforementioned address.

Miscellaneous

How long will it take to receive a response after requesting insurance records and/or lien information?

Fidelis Care responds to inquiries for the release of insurance records and/or lien information in the order in which they are received. Due to the large number of requests received, a response may take up to approximately 30 calendar days from the date Fidelis Care receives the request. An expedited response may be warranted if a court date is pending. In such case, a copy of the underlying scheduling order must be submitted with the request.


Can I fax/email my initial insurance record request and follow up inquiries to Fidelis Care?

No. Fidelis Care does not respond to inquiries received via fax, email or phone. All requests for insurance records and information regarding liens and/or subrogation must be mailed to:

Fidelis Care
Attn: Legal Affairs
95-25 Queens Boulevard
Rego Park, NY 11374

Is there a specific authorization form that must accompany my request?

No. Fidelis Care will accept any authorization form, as long as it is HIPAA compliant and notarized.


Do I need to include a HIPAA authorization form?

Yes. For all Record Requests to send records to a third party. For example, requests made by a law firm, attorney, or representative. Download a copy of a standard HIPAA form.

Why does Fidelis Care request that the HIPAA authorization form be notarized?

Fidelis Care imposes this requirement with the HIPAA authorization form in order to protect our member’s privacy.


Is there a telephone number I can call to follow up on my request?

No. If you have not received a response within 30 calendar days, you may follow up in writing to:

Fidelis Care
Attn: Legal Affairs
95-25 Queens Boulevard
Rego Park, NY 11374