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~ • • <br />' EXHIBIT E <br />COST CONTAINMENT FEATURES <br />' A. Mandatory Focused Second Surgical 0 ip'nion <br /> When surgery is unnecessary, patients are unwisely subjecting <br /> themselves to substantial physical risk and expense. A Mandatory <br />' Focused Second Surgical Opinion Program will assist the patient in <br /> determining when surgery is necessary and if it is necessary, whether <br /> it can be performed on an outpatient basis. <br />' Proposed Changes• <br />' James Benefits proposes that the City r~egui~re its employees and their <br />l <br /> dependents to receive a second surgica <br />opinion for those elective <br /> procedures listed below, and if the second opinion conflicts with the <br /> first opinion, provide an option for the employee or their dependent <br />to receive a third o <br />inion <br /> p <br />. <br /> 1. Bunionectomy (removal of bunions) <br />' 2. Removal of Cataract <br /> 3. Cholecystectomy (removal of gall bladder) <br /> 4. Coronary bypass <br /> 5. Dilation and curretage <br />' 6. Hemorrhoidectomy (removal of hemorrhoids) <br /> 7. Hysterectomy (removal of uterus) <br />' 8. Inguinal herniorrhapy (repair of inguinal hernia) <br />9. Knee arthroscopy and surgery <br /> 10. Laminectomy (removal of part of vertebrae) <br /> 11. Ligation and stripping of varicose veins <br />' 12. Mastectomy and other breast surgery <br /> 13. Prostatectomy (removal of part or all of prostrate gland) <br /> 14. Submucosus resection (repair of deviated septum) <br /> 15. Temporomandibular Joint Surgery <br />' 16. Tonsillectomy and/or adenoidectomy (removal of tonsils and/or <br /> adenoids) <br />' Continuing the current practice, eligible expenses for the second and <br /> if necessary, the third opinion should be covered 100%. However, if <br /> employees or their dependents receive any surgery listed above <br /> without first receiving a second surgical opinion, it is recommended <br />' that all charges associated with the surgery be subject to the <br /> deductible and be paid at 50%; thereby requiring a 50% copayment of <br />' the patient. Also this 50% patient copayment should not contribute <br />to out-of- <br />ocket limits for thi <br />l <br />n <br /> p <br />. <br />s p <br />a <br /> <br /> <br />1 ~ eE~~ <br />