[Congressional Record (Bound Edition), Volume 148 (2002), Part 12]
[Extensions of Remarks]
[Pages 16115-16116]
[From the U.S. Government Publishing Office, www.gpo.gov]




                      SECOND OPINION COVERAGE ACT

                                 ______
                                 

                            HON. SUSAN DAVIS

                             of california

                    in the house of representatives

                      Wednesday, September 4, 2002

  Mrs. DAVIS of California. Mr. Speaker, today, I am introducing the 
Second Opinion Coverage Act of 2002--legislation that will ensure the 
accessibility and coverage of medical second opinions.
  The Supreme Court's ruling this past June rekindled the debate 
surrounding managed care coverage. Patient protections and the need for 
a Patients' Bill of Rights again became topics of everyday 
conversation. Yet, Congress still has much work to do on crafting a 
strong Patients' Bill of Rights that can address patient needs.
  In my opinion, the first step to enacting any sort of comprehensive 
health care reform is to provide patients with access to appropriate 
medical information. This is why I am introducing the Second Opinion 
Coverage Act.
  As a member of the California State Assembly, I heard from a number 
of patients who saw a gap in their existing health care coverage. They 
wanted a clear process for medical second opinions. In particular, 
patients with challenging health conditions encountered difficulty 
obtaining a second opinion through their health plans. These patients 
faced complex procedures and wanted to be sure they were well educated 
about their treatment opinions.
  Anyone who has ever experienced the prospect of surgery knows the 
value of receiving a second opinion. The peace of mind provided by a 
second professional's opinion, in addition to the value of new 
information received, is immeasurable. Indeed, second opinions can 
result in better patient care because of the increased dialogue about 
treatment options, and can also benefit health plans by potentially 
reducing the number of invasive procedures.
  After meeting with patients, physicians and health groups, I authored 
a law in California that guarantees coverage of second opinions. If 
patients meet any one of five qualifying conditions, they 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.
  While I can describe the benefits of this measure, I believe that 
individual experiences best demonstrate the value of enacting second 
opinion legislation. John Torres, one of my constituents, shared with 
me his family's experience with medical second opinions. In 2000, a 
surgical procedure was recommended for Mr. Torres's young son, 
Nicholas. A consultation from another physician confirmed that a less-
invasive procedure would effectively treat Nicholas's condition. The 
second opinion provided the Torres family with crucial information that 
helped them make the right decision for Nicholas. I am happy to say 
that Nicholas responded well to the treatment and is now an active 
seven-year old.

[[Page 16116]]

  The law in California provides a good first step by offering a 
straightforward process for addressing second opinion requests for many 
in my state. Unfortunately, this legislation does not cover 4.3 million 
Californians enrolled in self-insured, federally regulated health 
plans. Nationwide, this translates into 56 million persons without 
guaranteed access to second opinions. All patients should have access 
to a full discussion and disclosure of their medical options.
  I urge you, Mr. Speaker, and all of my colleagues to pass this 
critical legislation quickly into law.

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