(English source text)

 

Second or Third Opinions 
In the event that you dispute either the diagnosis or the treatment prescribed by the treating physician, you may obtain up to two additional opinions from physicians within the MPN.

• You will be required to continue your treatment with your treating provider or a provider of your choice subject to the rules on treatment and change of physicians within the MPN.

 

• You have the right to request a copy of your medical records that will be sent to the second or third opinion physician

• You will be responsible to inform the Intracorp case manager or, if there is no Intracorp case manager involved, REM, LTD, that you dispute the treatment being provided and are requesting a second or third opinion.  The REM, LTD will then contact an Intracorp case manager to help you in selecting a physician or specialist from a list of MPN providers and facilitate a prompt appointment, within 60 days or less.

 

• Once your appointment is made you must inform REM, LTD of the appointment date.

• If you do not make an appointment within 60 days, you will not be allowed to have a second opinion with regard to this disputed diagnosis or treatment of this treating physician.

 

• REM, LTD will notify the selected provider in writing that you have selected him for a second or third opinion and the nature of the dispute.  You will be copied on this letter.  REM, LTD will also send the provider the necessary medical records prior to your appointment.  If, after receiving your medical records, the provider feels that your injury is not the type of injury he or she normally treats, the providers office will notify you and REM, LTD will provide you with additional providers or specialists from which to make another selection.

• The Intracorp case manager will follow-up with the provider to ensure the physician renders his or her opinion of the disputed diagnosis or treatment in writing and offers alternative diagnosis or treatment recommendations if applicable. The second and third opinion physicians may order diagnostic testing if medically necessary.  Within 20 days of the date of the appointment or receipt of the results of the diagnostic tests, whichever is later, a copy of the written report shall be provided to you, the Intracorp case manager, REM, LTD and the treating provider.

 

• When you request a third opinion, REM, LTD will send you an Independent Medical Review Application form with the “MPN contact” section completed.  If, after the third opinion, you still disagree with the diagnosis or treatment, you may request an independent medical review.

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[Traditional Chinese target translation]

 

第二或第三選擇

如果您對於主診醫生的診斷或治療持有異議，您可以從 MPN 內另選兩名醫生。

• 您必須按照關於 MPN 醫生的治療及變更的規定，繼續接受醫療服務商或者您選擇的服務商的治療。

 

• 對於交給第二位或第三位醫生的醫療記錄，您有權索要副本。

• 您有責任通知 Intracorp 病案主管（如果沒有 Intracorp 病案主管，則通知 REM，LTD）您對獲得的治療持有異議，並要求獲得第二或第三位醫生。之後 REM，LTD 將聯繫 Intracorp 病案主管，幫助您從 MPN 服務商名單中選擇一名醫生或專科醫生，並在 60 日內協助您儘快預約就診。

 

• 一旦預約成功，您必須將預約日期告知 REM，LTD。

• 如果您在 60 日內未進行預約，您將不得就這名治療醫生的此次有爭議的診斷或治療獲得第二位醫生。

 

• REM，LTD 將以書面方式通知被選中的服務商您已將他選爲第二或第三位醫生，以及爭議的性質。這封通知函中將轉載您的觀點。REM，LTD 還會在您預約之前將必要的病例交給該服務商。如果服務商收到您的病例後，感覺您受的傷害並非他或她平日治療的類型，服務商會通知您，而 REM，LTD 將爲您提供更多服務商或專科醫生，以便您重新選擇。

• Intracorp 病案主管將對服務商進行追蹤，確保該醫生就有爭議的診斷或治療提出書面意見，並在適當時提出其它診斷或治療意見。第二和第三位醫生可以根據治療需要預約診斷性檢查。在預約門診日期或收到診斷性檢查結果（以兩者中較晚的日期爲准）後的 20 日內，書面報告的副本將被提供給您、Intracorp 病案主管、REM，LTD 及醫療服務商。

 

• 當您申請第三位醫生時，REM，LTD 將寄給您一張“獨立醫療審查申請表”，其中“MPN 聯繫人”一欄已經填好。如果您對於第三位醫生的診斷或治療仍持有異議，您可以申請獨立醫學審查。