Trained staff gather pertinent information from each doctor and maintain that information in the specialist database. The doctors who provide SMOs are re-credentialed every two years at minimum, however if there is a change in the doctor’s information (practice location, change of hospital privileges, contact information, educational, etc.), his/her board certification is re-checked, and credentials updated.

The terms below are included in the employment agreement with all doctors as well as all employees and other independent contractors working for INDUASE and HIMC. All information is maintained in a confidential manner and is only used for the purposes of processing the second opinion.

The information required to assess a case includes but is not limited to; general information for the patient, a medical diagnosis, a detailed description on the medical condition and opinions from treating physicians if available, detailed medical history and results of all tests (medical, labs, imaging) performed. Also, if the patient has questions for the specialists, these should be included with the submission.

Our case submission function on the website is easy to use as you have probably seen already and intuitive regarding entering/uploading key patient information, medical history, medical and lab reports, images and associated reports. Once a case is received via the portal, medically trained personnel, including physicians and other medical professionals, review the details including all records and images uploaded, and operations support personnel track the notification of the associated physician(s).

As mentioned earlier this process is semi-automated and utilizes a patent-pending technology for matching an appropriate physician based on specialty. There are several factors in the algorithm including but not limited to availability of the physician that day/hour, subspecialty and even keywords used in case submission, language spoken, etc. Occasionally a physician’s own interest with the specifics of a case plays a role. Again, this is why circumventing this process to give the Client input on which specialist to use, is a bit complicated and could be counterproductive.

We work with independent doctors as well as with several networks of doctors and medical centers, contracted on an individual basis depending on the specifics of the case. The pool of doctors normally ranges between 3,000 and 3,500 and are all certified (approved and authorized to practice medicine) for their respective specialty, by the ‘American Board of Medical Specialties’ (ABMS).

Houston offers various other services related to the Second Medical Opinion Service. One of these primary products is to support our ‘medical audit’ service which supports partner reinsurance companies who reinsure our personal risk products, as well as to Health Care providers to help them manage their patient case load. The ‘medical audit’ service is used for reviewing claims for health-related insurance products as well as some life, accident and disability products. The audit service is included automatically in some of the products we develop to provide a ‘remote’ confirmation of a diagnosis and/or treatment plan, or a proposed surgical procedure, etc., before the insurer/reinsurer authorizes payout of the benefit. This service is also used to manage claims for our LTC product, working with local claims adjuster networks. This audit service is how HIMC originated back in 1993 and some years later evolved into what is now our International Second Medical Opinion service.

The service is done on a remote basis, without the patient having to leave his/her home. The insured/affiliate initiates the case via the entity where the services was contracted, or directly through INDUASE/HIMC depending on how the service is contracted. All the documents for the case are taken personally to the office of the Contracting Entity (EC) or is sent (via internet) to a designated person. The information is reviewed and then sent to INDUASE/HIMC via the www.houstonimc.us portal. The Medical Auditor receives and analyzes the information and using a proprietary system with a database of specialists in all pathologies across the United States, selects the specialist that is most appropriate to evaluate the case. The assigned specialist reviews the case and prepares his/her report, detailing a medical opinion on the diagnosis, the appropriate treatment course (or multiple options) and answers the insured/affiliate’s questions. This report is then translated into Spanish and is sent via electronic mail to the EC who contacts the insured/affiliate to deliver the report. In all cases, the consultation will be taken by a professional or interdisciplinary group of top international and reply within the following five (5) business days of receipt of the complete case in Houston.

The Second Medical Opinion service can be utilized for all types of consultations in all pathologies and medical specialties when the individual covered suffers or is diagnosed with a critical or grave illness defined as; potentially fatal, incurable, progressive, chronic and impacting the individual’s quality of life, or when the treatment for the condition creates an elevated level of risk to the individual’s life, is considered complex in its administration or results in further complications to their overall health. There is NO limitation as to the type of illness or medical condition that can benefit from an international medical consultation as long as it is considered to be of a critical, grave or complex nature and as such warrants an evaluation by a specialist in Houston. There is NO limitation based on pre-existence of a medical condition: any new occurrence of any chronic, grave or critical illness case may be submitted for review, regardless of when that illness was first diagnosed. There is NO limitation as to the number of times the same Assured may request an opinion on a given case as long as a follow-up consultation is warranted.