A few weeks ago, we released a proposed re-rate for our Mental Health item, so it was only fitting for us to also review Second Opinion. In this rating, we have included a sub-item reflecting whether an insurer offers access to international second opinion services. Best Doctors is one of the most well-known second opinion services currently in the market and you can learn more about them here
Four factor weighting
We have applied the following four factor weightings to second opinion:
Definition – proposed re-rate below
Incidence – 10% – to reflect the low rate of use of second opinion services
Frequency – 100% – to reflect that it could be used more frequently, depending on client and provider engagement.
Amount – 5% – calculated as a proportion of the total of the claims scenario
If you’re new to our four-factor methodology, would like a refresh or graphic to pass on to your clients, please click here
Sub-items rating review
Please find our proposed re-rate below.
The number of second opinion claims is low according to data we’ve received in the past, therefore a low weighting in our Research. We have created a sub-item to capture that AIA and ASB can request a second opinion as supporting evidence, this is to confirm whether a form of treatment or procedure is medically necessary or is greater than their reasonable charge. We have also included a sub-item to reflect whether an insurer offers access to international second opinion services, or an equivalent service, the most well-known being Best Doctors. If you do have any information on whether the score (currently sitting as a -10 deduction) for “Insurer does not offer access to international second opinion service” should be higher or lower, please let us know!
We value getting your feedback on how these wordings are being applied to claims you may be aware of. Please email us with details of any recent claims to help us update our understanding.
Doreen Dutt, Research Manager, Quality Product Research Limited, [email protected]