Board hears comparison of carrier second-opinion options; asks whether Best Doctors duplicates plan services

The board received a comparative briefing on medical expert-second-opinion options and the role of Best Doctors as an external review service.

Aon representative Anne Thompson summarized carrier pathways: Kaiser arranges consultations through member services and integrates results into the electronic health record; Blue Shield typically routes second opinions through a member’s medical group with prior authorization; UnitedHealthcare offers more flexibility for non‑Medicare members, allowing members to seek appointments without notifying the initial provider and, for Medicare members, permits a second and potentially a third opinion for major procedures.

Thompson noted reporting and coding limitations make tracking the total use of second-opinion services difficult. Commissioner Randy Scott framed the board’s core question: “whether Best Doctors was duplicating services that were being provided in the plans” and whether the $X per-member fee (described generically as a per-member overlay) is justified. (Note: the per-member-charge amount was discussed in prior materials and was not finalized on the record today.)

Physician-member Commissioner Paul Collins and others said Best Doctors appears to offer a case‑review by an expert in the specific issue, which some carriers do not routinely provide. Commissioners directed staff to seek follow-up data on utilization, referral patterns and whether carrier member services are consistently informing members about Best Doctors as an option.

Next steps: staff will pursue additional reporting from carriers and Best Doctors to determine overlap, potential savings or gaps and report back to the board.