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Dr. Zorba Paster: Steps to seek second opinions

Dr. Zorba Paster

Dr. Zorba: I have recently been diagnosed with AV nodal reentrant tachycardia . This fast heartbeat is driving me crazy. For years I’ve taken medications that break this rhythm, but it’s happening more and more often. That’s why my cardiologist recommended ablation therapy.

I’ve read about this. It’s scary. They thread a catheter from your groin into your heart and then electrically zap the highway that’s carrying the super-fast beat. She said it had a high success rate. I’m not sure I want this done, but I do hate these episodes.

I’m looking for a second opinion. How do I search for one? How do I know if it’s accurate? Will the second opinion be covered by insurance? This is my body – I want the best thing for it. – Ed from Oklahoma City

Dear Ed: Super questions – easy to ask but hard to answer. Let me give you the steps I’d take to sort this out.

First of all, you will want to teach yourself all about your disease. Knowledge is power. Go to a reputable specialty clinic website such as Johns Hopkins, Mayo Clinic or a university website. Medscape also is a good one. Online information is wonderful, but it’s also filled with noise and, frankly, garbage. Remember, as with all things, those who are unhappy tend to write the longest and most persuasive arguments.

Next, ask your primary provider for a recommendation. I would choose someone at a different clinic, in a different town preferably, someone who isn’t best buds with your heart doctor. Because medicine can be just like a guild, doctors often are reluctant to deliver a different opinion, especially if they work side by side with the original doctor.

Now, what about your insurance company, will they agree that the second opinion is necessary? I must tell you that when I deal with patients in my office who ask insurance questions, I always duck them because it’s so easy to be wrong and so difficult to be right.

Most insurers will say yes to the second opinion, with the caveat that you can’t have lab tests, X-rays or procedures at the new place. That means you have to take all, and I mean ALL, of your records with you, or it might be a dud visit.

With the advent of electronic medical records, getting your records can be a few keystrokes away. Make sure you do your homework and find out what the second opinion doctor wants.

But what if your insurer balks? They might say, no, we won’t pay for another opinion. Game over? Not at all. Insist on speaking directly to the medical director one-on-one.

If they still say no, then go to the next step, the grievance committee. They might not tell you there is one unless you ask, but let me assure you that I, for one, have never found an insurance company that doesn’t have a grievance committee. Insist on bringing it up with them; chances are if you have a legitimate case, they’ll say yes.

So now the hard part: What if you get two opinions and they differ? My simple answer would be to ask yourself who do you trust? What’s your gut feeling? Who is more credentialed?

But you shouldn’t make the decision alone. Call someone you know who is smart, savvy and, if possible, medically trained. Have them walk with you through this process. There’s a big difference when it’s a team effort. Stay well.

Dr. Zorba Paster is a family physician, professor at University of Wisconsin School of Medicine and Public Health, and host of the public radio program “Zorba Paster on Your Health,” which airs at noon Wednesdays on 91.1 FM, and noon Sundays on 91.9 FM. His column appears twice a month in The Spokesman-Review.
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