The wife of an IBEW member scheduled an appointment to have her doctor check out what was causing her searing knee pain. After an examination and an MRI, her doctor diagnosed a torn ligament and prescribed surgery to fix it.
Dreading weeks of painful rehabilitation, the IBEW spouse decided to seek a second opinion. And to get one, all she had to do was make a phone call, because her husband’s Family Medical Care Plan benefit through the IBEW provided access to the Best Doctors program.
Via Best Doctors’ Expert Medical Opinion service, the woman’s case was referred to one of the world’s top specialists — in this instance, the head of orthopedics at Boston’s Tufts Medical Center. That doctor determined that rather than a tear, the woman’s pain was being caused by early onset arthritis, so he prescribed a combination of an over-the-counter anti-inflammatory medication and a weight-loss program instead of surgery.
“When you’ve got important medical decisions to make, you’ve got to be completely confident that you’re making the right ones,” said International Secretary-Treasurer Kenneth W. Cooper, whose role includes oversight of the FMCP. “Best Doctors is one of the services we provide that helps deliver that confidence to participating members.”
About 180 IBEW local unions, in conjunction with their associated National Electrical Contractors Association chapters or other employers, so far have signed up to take part in the FMCP. Nearly 42,000 IBEW members are covered by the plan — a figure that more than doubles when factoring in members’ dependents.
“As more and more locals sign up, the plan gets stronger, and that allows us to reduce costs to continue to add services like Best Doctors,” Cooper said. “We’re not-for-profit and we don’t have the advertising or overhead of traditional insurers, so while overall health care costs in the U.S. have gone up 21% since 2007, FMCP’s are up just less than 5%.”
Best Doctors is one of the free services available to FMCP’s PPO participants. The program connects patients with a network of nearly 50,000 top medical experts representing more than 450 specialties.
With the Expert Medical Opinion service, these doctors access the patient’s relevant case information and then prepare an easy-to-understand confidential report containing their findings and advice.
“Statistically, about a third of recommended surgeries end up not being necessary,” said FMCP Executive Director Lawrence Bradley. “So, it can be prudent to consult another doctor and get a second opinion if you feel you could use one.”
A Best Doctors specialist could end up supporting the original conclusions of the patient’s physician or offering alternatives. Either way, the final decision about the next course of action is always left to the patient.
Best Doctors has been an FMCP benefit since the IBEW launched the health care plan in 2006, Bradley said. Since then, dozens of members and their families have taken advantage of the Expert Medical Opinion service with diagnoses changing for about 80% and treatment changing for 89%.
“Most family practice doctors spend the bulk of their days seeing patients,” Bradley said. “That’s not to knock their training or experience, but the specialists working with Best Doctors have the luxury of time to stay on top of the latest research and treatments.” These specialists can’t put themselves on the list, he noted; they have to be nominated by their peers.
The Best Doctors benefit also includes:
- Critical Care Support, where patients get a specialist’s quick guidance on serious situations or illnesses — even from the emergency room, if necessary.
- Ask the Expert helps answer patients’ questions about a diagnosis or treatment.
- Find a Best Doctor searches nearby and available in-network doctors and selects someone who can best meet a patient’s needs.
- Treatment Decision Support provides patients with access to resources that help explain their conditions and treatments.
- Behavioral Health Navigator is a relatively new program similar to Expert Medical Opinion that can review cases dealing with mental health concerns.
Contact with Best Doctors services is handled confidentially over the phone or via the internet, Bradley said. “You can get access to their advice without having to travel anywhere.”
“The FMCP is an attractive health insurance option for companies and signatory contractors looking to offer IBEW members and their families high-quality coverage at affordable prices,” Cooper said. The plan usually matches — and often surpasses — comparable coverage available from employer-provided insurance plans, he said. “Both sides can come away from the bargaining table happy.”