second surgical opinion

second surgical opinion

Managed care A cost containment technique to help Pts and insurance companies determine whether a recommended procedure is necessary, or whether an alternative method of treatment can accomplish the same result. See Second opinion.
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There has been a number of legislative mandates passed that has expanded benefits for things other than parity, including maternity benefits, second surgical opinion, and others.
For instance, second surgical opinion programs try to discourage unnecessary surgery by having patients obtain another opinion before committing to the surgery.
Other changes in health care benefits for active employees included up to 30 out-patient visits for mental health treatment, with reimbursement ranging from 90 percent for the first 10 sessions to 70 percent for the last 10 sessions; a $500 annual maximum for chiropractic services; a $400 annual maximum for hearing devices purchased from a non-network provider; a requirement for a second surgical opinion, with reimbursement ranging from 90 percent for an inarea provider to 60 percent for an out-of-area provider; and for employees under a health maintenance organization (HMO) plan, the establishment of a prescription drug plan similar to the network coverage and the imposition of a $5 employee copayment for doctors' office visits.
Second surgical opinion (SSO) is another service designed to influence employees' choice of treatment.
Outpatient utilization review and voluntary second surgical opinion were each mentioned by nearly 40 percent of the respondents.
6) Data on second surgical opinion provisions represents health care participants enrolled in plans other than Health Maintenance Organizations (HMO'S) because HMO'S do not offer outpatient surgery incentives.
The traditional components of UM programs are hospital admission review, concurrent review and second surgical opinion.
Other changes in the health care plan (most of which are effective January 1, 1991) include the requirement for a second surgical opinion for certain surgical procedures; a newly established copayment of $3 for generic drugs and $7 for brandname drugs; preventive mammography screening; payment of outpatient psychiatric care at 60 percent of reasonable and customary costs; payment at 80 percent for certain other outpatient sevices, such as pre-admission testing and second surgical opinions; improvements in dental coverage; and various changes to post-retirement health care benefits.
An enhancement to our I-Precertification, this product provides discharge planning, second surgical opinion and concurrent review as well as steerage and reporting capabilities.
Then as costs escalated, second surgical opinions and hospital precertification requirements were introduced.
Second surgical opinions, managed behavioral health and staff model HMOs all were front-runners in this endeavor.
Innovative medical management programs include detailed studies of medical categories that significantly contribute to rising health care costs and new approaches to second surgical opinions, utilization management and coordination of care.