[Congressional Record Volume 151, Number 81 (Friday, June 17, 2005)]
[Extensions of Remarks]
[Pages E1266-E1267]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      SECOND OPINION COVERAGE ACT

                                 ______
                                 

                          HON. SUSAN A. DAVIS

                             of california

                    in the house of representatives

                        Thursday, June 16, 2005

  Mrs. DAVIS of California. Mr. Speaker, today, I am introducing the 
Second Opinion

[[Page E1267]]

Coverage Act--legislation that will ensure the accessibility and 
coverage of medical second opinions.
  Imagine that your doctor tells you that you must undergo radical 
surgery that may threaten the use of a limb or leave you with a serious 
chronic condition. Understandably, you would request a second opinion 
from another physician. Most health care groups see the value in such 
requests and provide patients with a second opinion. Besides giving 
patients much needed peace of mind, second opinions can benefit health 
plans by reducing the number of invasive procedures and result in 
better patient care through increased dialogue about treatment options.
  However, when I was a member of the California State Assembly, I 
heard from a number of patients who experienced a glitch in their 
health care coverage. They noticed the absence of a clear process for 
obtaining medical second opinions. These patients, many struggling with 
challenging health conditions, had difficulties obtaining second 
opinions through their health plans.
  After meeting with patients, physicians and health groups, I authored 
a law in California that guarantees coverage of second opinions. 
Patients, meeting any one of several qualifying conditions, are 
entitled to a timely second opinion by a ``qualified health care 
professional,'' within 72 hours in cases of serious or imminent health 
threat. When another expert is not available within the provider group 
or network, the organization will pay for an appropriately qualified 
doctor outside of the plan. Patients are responsible for the costs of 
applicable co-payments.
  The law in California was a good first step. Unfortunately, this 
legislation does not cover the more than 4 million Californians 
enrolled in self-insured, federally regulated health plans. Nationwide, 
this translates into almost 51 million persons without guaranteed 
access to second opinions. This means that one in four insured families 
are not protected by California's own second opinion law! I believe the 
time has come to make access to second opinions a national standard.
  I urge you, Mr. Speaker, and all of my colleagues to pass this 
critical legislation into law.

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