MMC Benefits Handbook
How the Program Works
Best Doctors is an independent third-party provider that can help when you or covered family members face a medical decision. The Best Doctors expert second opinion service is an in-depth medical review from a world-renowned specialist. They utilize their list of best-in-class physicians to help you confirm your diagnosis and treatment plan options. And unlike traditional second opinions, the whole Best Doctors review process can take place over the phone, so you can call from the privacy of your home.
Best Doctors provides a confidential, easy-to-use service to help employees, family and household members answer questions like:
- Do I really need surgery?
- My doctor says it's cancer, but benign, what if it's not?
- What are the treatment options that I should consider?
Best Doctors provides you with a Member Advocate who is available to speak with you Monday through Friday, 8:00 a.m. – 9:00 p.m. Eastern time; after these hours you can leave a message, which is generally returned the next business day.
After you call, a Best Doctors Member Advocate will conduct an in-depth discussion with you about your medical condition, including obtaining a full health history of you and your family. After the discussion, following your written authorization, Best Doctors will gather medical records concerning your present condition and diagnosis.
When the records are received, the Best Doctors clinical team will conduct a comprehensive analysis of your clinical information. The team will select the appropriate specialist(s) for your medical condition to evaluate your case, based on the most up-to-date medical thinking.
Your Member Advocate will send you a report of the specialist's findings, summarized in an easy-to-read format, as well as a comprehensive Expert Report for your treating physician's reference. Best Doctors will speak with you about the report's findings and then deliver the report to your treating physician, unless you do not authorize it.
Throughout the process, the Member Advocate is available to answer your questions. At both six weeks and six months after you receive the report, the Member Advocate will follow up with you to see if you need additional help. Depending on the complexity of the case and responsiveness of an individual's current physician(s) to requests for medical records, the Best Doctors process takes two to eight weeks.
In addition, Best Doctors offers a Medical Records eSummary™. Through the Medical Records eSummary™, Best Doctors can collect and organize your medical records for you and provide them on an easy-to-access USB drive. You will also receive a personal Health Alert Summary based on the records collected, giving you a total snapshot of your medical wellness.
Who are the doctors that Best Doctors uses?
Best Doctors physicians are medical specialists selected through a comprehensive peer review process. Best Doctors surveys doctors nationwide, asking them for an assessment of the clinical abilities of their peers, and yielding highly qualitative insight into the medical profession. Doctors cannot pay to be included on the list, or nominate themselves for the list. Each physician is confirmed to be board certified in their specialty, licensed to practice medicine in their jurisdiction and have a clear disciplinary record. The Best Doctors in America™ database includes over 50,000 of the countries top physicians in more than 450 specialties and subspecialties of medicine.
What kinds of medical diagnosis qualify for this service?
There is no list of qualified conditions — just call if you are feeling unsure about something to do with your care. Most people who call Best Doctors are trying to make a decision about their care and they will support you in doing that.
Are there medical diagnoses that do not qualify for Best Doctors?
The Best Doctors expert medical review program does not provide consulting services for cases being covered under Workers' Compensation. Other cases typically excluded are retrospective reviews for the purposes of gathering specialists' opinions for medical malpractice actions.
When calling Best Doctors, what information will my family member or I need to provide?
You or your eligible family member will need to provide the company name and your name. You or your eligible family member should also have available any information regarding the issue, including contact information for your doctor and/or health plan provider. In addition, an authorization or release may be required.
Will Best Doctors be talking to anyone at my health plan provider?
If you request and authorize information to be shared, Best Doctors will release your report to the appropriate individuals (e.g. health plan provider case manager) involved with your care.
Do I have to follow the recommendation of Best Doctors?
No. You remain in full control of your health care decisions. The information you and your treating physician receive from Best Doctors is intended to help you make informed decisions regarding your treatment.
Are the doctors paid for their review?
Yes, they are paid by Best Doctors. There is no charge to you.
If I have an authorized unpaid leave of absence, can I still participate in the program?
If Marsh & McLennan Companies grants you an authorized unpaid leave of absence, coverage for you and your family members continues for the duration of your authorized period of leave.
If I become disabled, does the Plan still provide a benefit?
During a period of approved disability, you and your covered family members remain eligible for coverage.
If I die
If you die while you are an active employee, your eligible family members may be eligible for coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). For information on COBRA, see "Continuing Coverage" in the Participating in Healthcare Benefits section.
If I no longer satisfy the Plan's eligibility requirements
Your coverage ends on the date you no longer satisfy the Plan's eligibility requirements. Coverage for eligible family members ends when yours does.
When coverage ends, COBRA coverage may be available, as described under "Continuing Coverage" in the Participating in Healthcare Benefits section.
If my family member loses eligibility status
If your family member no longer meets the eligibility requirements, his or her coverage ends.
Family members who lose coverage may be eligible for coverage under COBRA provisions as described under "Continuing Coverage" in the Participating in Healthcare Benefits section.
Do I have to use this program?
No. Participation is completely voluntary.