02 Mar / 2016
Florida Healthcare Laws: Your Right to a Second Opinion
After receiving a troubling medical diagnosis, there is sometimes confusion regarding the accuracy of the diagnosis as well as the recommended treatment options. Many people often want a second opinion to help decide what to do. Obtaining a second opinion could be costly, but in Florida you may not have to choose. Florida recognized the need for second opinions after obtaining certain medical determinations and acknowledged that the benefits of a second opinion far outweigh the costs. Soon after, Florida became one of the few states to enact legislation that outlines the instances in which an enrollee is entitled to seek a second medical opinion.
When are you entitled to a second opinion?
In Florida, a health organization is obligated to allow a second opinion when an enrollee disputes a healthcare organization’s or a physician’s opinion relating to a surgical procedure. If you have been to a doctor and you do not agree with the doctor’s finding about the reasonableness or necessity of a surgical procedure, then you have the right to obtain a second opinion. Additionally, a health organization is also obligated to allow a second opinion when you are subject to serious injury or illness. In these circumstances, a second opinion will be beneficial unless your condition is life-threatening and requires immediate action.
What are the costs associated with a second opinion?
The reality for many Americans is that there are very little savings accumulated at the end of each month. With rising healthcare costs, doctor’s visits are a cause for concern. If you seek a second opinion from a physician that is “in network” with your insurance plan, your fees may be less. You have the ability to choose the physician that will provide the second opinion. If a physician is “in network”, the organization may not charge any more than the fees established by contract for a referral contract physician. If the physician is not “in network”, your health insurance is required to pay the amount of all charges that are usual, reasonable, and customary in the community. However, you may be required to pay up to 40 percent of the fees for physicians that are not “in network”.
What are the limitations surrounding special opinions?
Generally, you are limited to obtaining three second opinions per year. After that, an insurance company can deny subsequent costs if they determine that you over utilized the second opinion privileges. Additionally, you should be aware that there are exceptions for those with chronic and disabling conditions and should ask your insurance company directly about this.
Florida’s statute requiring health insurance providers to cover all or some of the costs associated with a second opinion is a benefit that many Americans don’t have. However, the process is not seamless. You should contact your insurance company to ask them specifically about their policy regarding second opinions.
At Bounds Law Group, we limit our practice to Medical Malpractice. If you believe you or your family may have been a victim of Medical Malpractice, we would be happy to speak with you. Call us at 877.644.5122.
Using data from the National Practitioner Data Bank, 66,426 claims paid against 54,099 physicians were analyzed from 2005 through 2014. Approximately 1% of all physicians accounted for 32% of paid claims. Results: a small number of physicians with distinctive characteristics accounted for a disproportionately large number of paid malpractice claims. The study was published in the New England Journal of Medicine.
At Bounds Law Group, we are seeing similar statistics. While the vast majority of physicians and hospitals are excellent, there are many, unfortunately, that are not. If you believe you or your family may have been a victim of medical malpractice, we would be happy to speak with you. At Bounds Law Group, we limit our practice to Medical Malpractice. Call us at 877.644.5122.
10 Jul / 2013
As we age, various parts of our skeletal system begin to decline in function and can even fail. Often the points of failure are our joints including the knee joint and the hip joint. Medical science has created ways of replacing these joints with mechanical devices. You may know them as artificial hips and knees. The medical device industry calls them prosthetic replacements. These devices are made of exotic materials including cobalt, chromium, titanium and ceramics. We often feel that if a physician proposes these implants, that they have been tested and found to be safe by the FDA to be placed in the human body. Unfortunately, some of these devices have gone through what can best be described as a shortened approval process called a 510(k) submission. An example of a 510(k) submission approval is the Stryker Rejuvenate Modular Hip system which was submitted to the FDA for approval to market on April 4, 2008 and was approved only two months later on June 3, 2008.
Unfortunately, the Stryker Rejuvenate Modular Hip System demonstrated some possible problems to the patients it had been implanted in including corrosion at the modular neck, increased or excessive metal debris in the area of the hip joint which may have led to adverse local tissue responses, tissue inflammation and metallosis in the patients. These conditions can cause pain or inflammation in the hip area or lumps to form under your skin. This happens when the two parts of the hip implant rub against each other. This can send metal debris into the surrounding tissue and bloodstream. Metallosis occurs when the metal shavings deposit into the healthy tissue surrounding the implant. This metal debris kills the tissue. Health pink tissue becomes gray or black in color as the metal settles into the body.
If you have had this device implanted, your doctor can examine you to determine if you have this complication. They can use a blood test to determine whether you have elevated chromium and cobalt levels. They will also examine you to determine if you have formed any lumps under your skin. These lumps are called pseudo-tumors. They are fluid-filled sacs which are a result of your body attempting to isolate the poisonous metal. Sometimes these pseudo-tumors can only be detected using an MRI.
Unfortunately, you may be more likely to have these complications if the implant you received was a Stryker Rejuvenate or ABG II Modular type of implant, or a DePuy ASR XL Acetabular or ASR Hip Resurfacing System. The two companies that manufacture these implants have recalled them due to the significant number of complications resulting from these implants and, as a result, additional surgeries to replace the original hip implant.
While medical science has made great strides in the creation of medicines and devices to improve our longevity and quality of life, not all of their products are as safe and effective as we would hope. Occasionally, a multitude of factors come together to allow an unsafe device to be approved and used in patients. The results can be catastrophic.