Does Medicaid Cover Second Opinions in 2022?
Second opinions are, in the words of many within the healthcare industry, essential in the case of critical illness and should be the 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?
Here’s where it gets tricky: patients from less populated areas may have 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 specialty hospital further away. As a solution to this problem, a growing number of hospitals are implementing platforms like Purview’s Expert View, which powers remote second opinions by capturing and consolidating a patient's electronic files and presenting the relevant health information to a remote specialist for diagnosis.
While solutions exist to improve access by delivering remote second opinions, patients still face financial barriers to this care. Most private insurance policies do not cover remote second opinions or remote consultations with a specialist. That means patients may be required to pay out-of-pocket for the hospital charge, which could amount to $500 to $2,500. Assuming a patient in financial need can find someone to subsidize this fee, the patient may risk being disqualified by a program like Medicaid.
Though we are halfway there on overcoming both the financial and geographical barriers to getting a second opinion, the two do not yet meet in the middle.
Even if Institutions begin accepting insurance for remote consultations, public insurance options like Medicare and Medicaid may not be included. For example, the top three cancer institutions in the U.S. today do not accept out-of-state Medicaid for any of its services. Remote second opinions are treated similarly.
How Do I Get a Second Opinion with Medicaid?
Purview has established the Mike Shane Memorial Fund to fill this Medicaid second opinion gap for patients with 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 following a year-long 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 afford to make the trip to visit a specialist at MD Anderson Cancer Center in Houston, Texas.
Mike understood that many people don't have the resources necessary to seek this second opinion and receive the highest level of care. The charity that is his legacy believes that essential, life-saving healthcare should not be limited to those with private insurance or their own financial resources to obtain 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 a needed second opinion.