REMOTE SECOND MEDICAL OPINION
REMOTE SECOND MEDICAL OPINION is the subject, which is under consideration of Health Insurers in India and some of them have selectively included this aspect within the scope of Health Insurance Policies. What is the meaning of “REMOTE SECOND MEDICAL OPINION” and what relation it has with Health Insurance Policies? To understand the concept we need to look into the following aspects elaborately.
The need for a patient to go for second medical opinion can arise when he/she has a very serious or life threatening disease, where the diagnosis is not clear and where no established consensus on approved treatment, where the treatment is risky, where the patient is considering participation in a trail for a new drug or considering new experimental procedure involving use of experimental instruments or devices.
Invariably in the above situations the patient or his family members choose to go for second medical opinion before taking final decision for treatment or surgery. However in that case the vital question that comes in front of the patient is whether such second medical opinion should be obtained with the knowledge and involvement of their chosen physician or surgeon. This is a tricky situation. Often such situation may lead to creation of mistrust and may also create an apprehension in the mind of the patient that the treating doctor may feel insulted. However the advantage of going for second opinion by taking chosen physician or surgeon into the confidence is that all the medical records and pathological tests done by the patient’s doctor needs to be presented to the doctor giving second medical opinion. Also if two experts discuss the issue in an open way what the areas of agreement and disagreement are it will be beneficial for arriving at a conclusion. Therefore it is always advisable to go for second medical opinion by taking own doctor into confidence. At times even the treating doctor himself suggests for second medical opinion. However, the difference between own doctor suggesting for second opinion and patient seeking to go for second opinion is that the own doctor may prefer to go for such opinion from his choice of doctor or from his senior and in such case the confidence level between consulting doctors remain comfortable whereas in the case of patient selecting to go for second medical opinion such confidence level may not be there and possibility of disagreement on contrary views remains very much.
Another aspect pertaining to second medical opinion is that the patient himself requests the doctor to seek second medical opinion before proceeding with the suggested treatment or surgery. However, the immediate and possible consequence of such a proposal to the doctor is that he/she may feel lack of confidence of the patient on his judgment. Also if he/she has to arrange for the second medical opinion he/she may approach a doctor or institution which in all likely-hood will strengthen his line of approach. It will, therefore, be a better proposition to select doctor or institution by the patient keeping in mind the importance of seeking such opinion from an institution or doctor having different institutional culture or philosophy to consider and give their findings and suggestion for the case in an independent manner.
From the patient’s point of view the need for going to seek second medical opinion is to confirm and make it doubly sure that he/she is going to get the correct and appropriate medical treatment which will give him/her best possible result. However it may not always be the case where results of second medical opinion will put the patient in a comfortable position to take right decision. If the opinion confirms the diagnosis and line of treatment or surgery suggested by the first doctor, particularly when such confirmation comes from a doctor or institution independent of the first doctor’s choice, it becomes easier for the patient to take his/her decision quickly. It is when such second opinion grossly differs from the findings and suggestions of the first doctor, chances of which cannot be ruled out, the position of the patient becomes awkward. Also there are two aspects of the second medical opinion, one that the findings as to the diagnosis and second for the line of treatment or surgery. When the outcome as to the diagnosis matches with the original findings it confirms the medical problem faced by the patient. However, when findings as to the diagnosis grossly differ at two levels it puts the patient in a great dilemma. For the second aspect i.e. line of treatment or surgery, it is again the same case when it confirms with the suggestions of the original doctor the patient find himself in an assured position. However, it is a known fact that some doctors and institution believes and follow the conservative approach whereas others believe in aggressive and (tested / untested) new approaches. Any suggestions for the remedy of the patient’s problem based on these two beliefs may again result into different opinion for line of actions and patient will find himselfherself again in awkward position.
When patient finds himself in such awkward situations after obtaining second medical opinion he/she is left with choice of either to go for third or more medical opinions or take a difficult decision on the basis of two different findings. In today’s modern world the option of obtaining second medical opinion from the doctors and/or institutions of foreign countries is also available. Even the cases where finding as to the diagnosis or line of treatment / surgery grossly differs, particularly where the nature of disease is critical, can be referred to such foreign doctors or institutions.
RELATION OF SECOND MEDICAL OPINION AND INSURANCE COVER
The question arises what relation the second medical opinion has with the provisions of health insurance plans. As is said at the beginning that the subject of this aspect is under consideration of the Insurers and some have included provisions for REMOTE SECOND MEDICAL OPINION selectively under some of their health insurance plans. As such what is the implication of this new provision for the insured?
The first and foremost question that arises is whether the cost incurred towards professional fee and investigations associated with second medical opinion are covered or not under the basic health insurance plans even if this new provision is not included under the policy? The answer is yes it is covered under the basic policy itself. However the difference is that under the basic cover the cost is covered under the provision of “Pre & Post Hospitalisation Expenses cover”, which provides a limited cover of normally 10% of the sum insured for all relevant pre and post hospitalization expenses including second medical opinion. Normally such opinion is obtained prior to the hospitalization as such the coverage for reimbursement the cost for second medical opinion is considered when such opinion is obtained within the time limit prescribed (normally 30 days) for pre-hospitalisation cover under the policy.
TERMS & CONDITIONS OF THE NEW PROVISION
The cover for REMOTE SECOND MEDICAL OPINION, which is provided by the insurers in their health plans now a day however has certain specific and limited provisions. The salient features of such cover are as under:
- The Insurer will arrange and pay for the selected qualified medical conditions only (normally for chronic diseases such as heart diseases, cancer, liver and kidney diseases etc which are specifically mentioned under the policy) for which the diagnosis is made and the course of treatment is recommended by the local physician;
- Such medical opinion can be obtained from only empanelled ‘World Leading Medical Centre (WLMC)’;
- The Insurer shall identify the names of three WLMCs, having expertise in concerned case, from which the patient or his family members must select one WLMC from which they would like to obtain second medical opinion based on inputs of his/her local Physician;
- The second opinion on the diagnosis and the recommended course of Treatment would be provided directly to the Insured Person;
- Only one time opinion can be obtained during policy period; and
- The Insurer will not be responsible for any legal liability due to any error or omission or representation or consequences of any action taken in reliance of the Remote Medical Second Opinion provided by the World Leading Medical Centre.
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