Are Medicaid Patients Being Denied Second Opinions?

Posted by Purview on Sep 24, 2019 11:48:00 AM

Second opinions are, in the words of many within the healthcare industry, essential in the case of critical illness and a right of every patient. Most insurance plans, including Medicare and Medicaid, cover or even require an in-person second opinion consultation with a specialist prior to treatment. Medicare even pays for a third opinion if the second opinion differs significantly from the first.

Sound good so far?

Maybe.

Here’s where it gets tricky: patients from less populated areas may have very few specialists within their region, or none at all, and only those with the financial resources can afford the travel costs and time-off required to visit a speciality hospital further away. As a solution to this problem, a growing number of specialty hospitals are implementing platforms that offer remote consultation on these cases such as Purview’s Expert View, which consolidates a patient's electronic files and clearly presents the relevant health information to a specialist for diagnosis.

Problem solved?

Not yet.

Even more frustrating, while a solution for the geographical barrier is available, the financial barrier remains. Most insurance companies do not cover remote second opinions or consultations, meaning the hospital charge is often significant for this service; and the kicker —even if someone covered by Medicaid somehow comes up with a way to pay the fee out-of-pocket (at the price tag of $500-$2,500 depending on the case and the institution), they risk losing their insurance entirely.

Though we are halfway there on overcoming both the financial and geographical barriers to getting a second opinion, they do not meet in the middle.

Similarly, even when these institutions are able to accept insurance for remote consultations -- which they likely will, considering the popularization of these platforms and current reimbursement reforms supporting digital health-- public insurance may not be included. For example, the top three cancer institutions in the U.S. do not accept out-of-state Medicaid for any services, and remote second opinions are likely no different.

Purview has established the Mike Shane Memorial Fund to fill this gap for Medicaid patients suffering from cholangiocarcinoma, a rare form of liver cancer. Mike Shane was a close friend and supporter of the Purview team, who tragically lost his life to cholangiocarcinoma after a yearlong battle. After his initial diagnosis, Mike sought a second opinion on his diagnosis and treatment plan. Though he lived in Dayton, Ohio, Mike was able to make the trip to visit a specialist at MD Anderson Cancer Center in Houston, Texas.

Mike understood that he was privileged to have the resources necessary to seek this second opinion and receive the highest level of care, and that many do not have that privilege. Why should essential, life-saving healthcare be limited to those wealthy enough to afford private insurance or self-pay for the best care the industry has to offer?

Through the Mike Shane Memorial Fund, Purview is working to close the gap for patients who can't afford or access a needed second opinion.

Topics: Expert View, second opinion, medical opinion software, medicaid, Mike Shane Memorial Fund, medicare

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