Why Second Medical Opinions are a Must for Employer Groups, TPAs, and Insurance Companies

July 7, 2021 by Manuela Pujals Lord, M.S.

Working in the health care industry, we can all agree that the one unifying quality is that we’re here to be of service to the patient, either directly or indirectly. As a strategic business development executive with over fifteen years of experience in international business development and health insurance, I realize how privileged I’ve been to help people while working for health insurance companies, hospitals, or Third-Party Administrators (known in the industry as a TPA).

The Impact of an Expert Second Medical Opinion

I saw the value of an expert second medical opinion in full force while working for a TPA. In one instance, a patient lived on an island where specialty care was limited. The patient’s rare medical condition required expensive, off-island medical care, and it was important that the diagnosis was confirmed before sending the patient to just any hospital. Establishing the right diagnosis is critical so that the patient does not endure unnecessary treatment, nor does the employer or insurance company incur unnecessary medical expenses. 

With advancements in medicine, working with a company that provides a co-diagnosis or alternate treatment of care is a must—not only for financial reasons but for humane ones. Patients should have access to a co-diagnosis by an independent entity to provide them peace of mind and adequate care.

This wasn’t the only time I saw the impact of a second medical opinion. When I was working at an international insurance company, a second medical opinion was required for any treatment greater than $50,000 to control the insurance company’s stop-loss. This protocol ensured that the correct procedure was done at the correct facility, providing the best health outcomes, and helping companies avoid unnecessary expenses.

Even hospitals rely on second opinions. At one of the ones I worked with, they obtained a second medical opinion in order to provide the best care from the beginning. That way, they didn’t interrupt the patient-care experience or realize too late that the patient needed to be at another type of facility. This second opinion helped the hospital avoid unnecessary treatments, transports, and costs to the insurance company, ultimately doing right by the patient and preserving their reputation with insurers.

Second Medical Opinions Should be a Commodity for All Insurance Plans

Pairing my previous experience with my new role as the Southeast Regional Vice-President at MORE Health, I can attest to the value and necessity of an expert second medical opinion for the patient’s peace of mind and experience, the hospital’s reputation and liability, and cost containment for TPAs, insurance companies, and employer groups.

COVID-19 has changed the world. It has also proven the importance of the right diagnosis and treatment at the right time. Second medical opinions should be a commodity for all insurance plans. Self-insured groups also greatly benefit from second medical opinions. In fact, Population Health Management reported, “The implications of misdiagnosis cost “$3.8M per 10,000 employees per year, in addition to any medical costs.”

Common goals for TPAs, health insurance companies, and hospitals include cost containment, specialty care, and providing options to deliver the correct diagnosis out of the gate. This ties in nicely with the goals I have set for MORE Health in the Southeast region:

  1. Provide payors and patients access to the best medical minds in the world
  2. Create awareness of the importance of an expert second medical opinion 
  3. Make second medical opinions mainstream in the healthcare industry 

Whether in the United States or abroad, I look forward to guiding employer groups, self-insured groups, TPAs, and insurance companies through cost containment strategies to maximize the patient experience as well as the productivity of the employee.

If you are interested in learning more about MORE Health or would like to schedule a meeting to discuss how this benefit can help your organization improve patient care and save money, contact us or send us an email to sales@morehealth.com.

About the Author

Manuela Pujals Lord is a seasoned professional in international managed care, international hospital departments, international travel insurance, and the air ambulance industry.  She has developed and maintained a network of international and domestic healthcare connections in the travel insurance and private medical insurance arena and for centers of excellence in the U.S. She is the Southeast Regional Vice-President at MORE Health and is fluent in four languages: English, Spanish, French, and Italian.

About MORE Health

MORE Health, a global digital health company, provides peace of mind and confidence to patients when they need it most—when facing a serious life-changing illness. Delivering second medical opinions virtually, MORE Health delivers a diagnosis and recommended treatment plan from the world’s best medical minds. This collaborative approach to diagnosis puts the patient at the center of the process—empowering them to make informed decisions regarding their healthcare. Offering all the benefits of a second opinion, the service ensures that the attending doctor and the expert physician specialist are aligned through their proprietary, GDPR- and HIPPA-compliant Physician Collaboration Platform™, thus minimizing errors while also resolving potential conflicts regarding the diagnosis and treatment plan developed. Since 2013, MORE Health has helped patients on six continents and continues its mission to provide clients and their members access to the best medical minds in the world—when they need it most.

Request a Demo
Social Wall