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 healthcare 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 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. In addition, 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 worked 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 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 its reputation with insurers.

Second Medical Opinions Should be a Commodity for All Insurance Plans

COVID-19 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 want to learn more about MORE Health or schedule a meeting to discuss how this benefit can help your organization improve patient care and save money, contact us or email us at 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. 

About MORE Health

MORE Health is a global digital health company known for giving individuals access to the best medical minds in the world when facing a serious illness or diagnosis. Recognized as a leader in cross-border telemedicine, MORE Health delivers virtual Expert Medical Opinions from world-leading specialists by pairing technology and world-class service. Offered as an employee benefit or on an individual self-pay basis, this service is available to groups of any size in the U.S. and abroad. Since 2013, MORE Health has helped patients on six continents and continues its mission to provide patient advocacy to clients and members worldwide—when they need it most.

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