Affiliates of the Mass General Brigham system include Harvard Medical School teaching hospitals.
The Mass General Brigham doctors providing second opinions are leaders in medicine, research and training.
Our case coordinators will guide you and your family through every step of the consultation process.
Identifying the most appropriate expert specialists in our network to comment on particular diagnoses
Conducting imaging and biopsy reviews to affirm, adjust or change original diagnoses
Confirming treatment plans, therapies and interventions—or recommending alternatives
Providing guidance on medication management and pain management strategies
With OSO, you can avoid the time and expense of traveling to receive the very best specialty consultation.
Plus, you and your doctor will have the confidence that comes with our diagnosis and treatment plan reviews, thus avoiding unnecessary testing and procedures. That means greater peace of mind for you and your loved ones.
This is the base cost for a medical second opinion. We encourage you to provide specific questions that you would like the reviewing doctor to address in the consultation letter. Doing so is helpful to the reviewing doctor and ensures you and your referring doctor receive useful input and recommendations. Please note: There is an additional fee if you request an imaging and/or biopsy review, include more than four questions for the reviewing physician or use the Health Advocate medical record collection service. See below for details.
An imaging review involves an interpretation of imaging examinations, such as computed tomography (CT or CAT) scans or magnetic resonance imaging (MRI) scans. Pricing depends on how many different parts of the body are being reviewed. Each imaging site is considered a separate study.
A biopsy review involves an interpretation of pathological specimens, which may take the form of slides or blocks. Pricing depends on how many different parts of the body are being reviewed. Each biopsy site is considered a separate study. Please note: There is an additional fee for reviews of blocks or unstained slides, or if special staining of slides is required for interpretation.
In order to make the consultation process as easy as possible for you, we have partnered with Health Advocate. This third-party service will manage the collection and submission of all medical records and test results required for your second opinion.
Submitting more than four questions (including multi-part questions) in your request will incur an additional fee. Clarification questions are allowed after a consultation, but there is an additional fee for follow-up questions.
Also, the following fees apply for medical records with more than 50 pages:
|51 - 75||$25|
|76 - 100||$50|
|101 - 125||$75|
|126 - 150||$100|
|151 - 175||$125|
|176 - 200||$150|
|201+||Contact us to discuss|
If you have any questions about costs, please contact us at firstname.lastname@example.org.
Dear Referring Physician,
Thank you very much for your consultation regarding female patient, DOB: 1/25/1967. I have reviewed the medical records that were provided as well as the imaging. My findings and opinion regarding her case follows:(1)
Chief complaint: Bilateral forefoot pain(2)
She has suffered with bilateral hallux valgus for a few years, however, in 2015 following a 3-day trekking holiday the condition worsened considerably.
Walking is limited and has declined markedly over the last 2 years.
She describes pain as chronic, although reluctant to take oral analgesia she prefers topical treatments, ice packs etc. Although provided with Orthotics, she was never advised to change them after wearing them of 6-7 months, and consequently her foot pain increased. She is now waiting for new ones, and expects them next week.
Generally, in good health, no associated health problems that may affect her hallux valgus.
She is awaiting new pair of orthotics, only to be worn with comfortable low heeled walking shoes. She is reluctant to take oral analgesia despite chronic pain; prefers topical remedies such as ice packs.
No pain when wearing house slippers, otherwise pain is experienced when wearing all types of other foot wear. She expresses concern that having to wear orthotics in the summer will only increase her foot pain, as she is unable to wear sandals.
The patient has been advised that if it is progressing it was likely to continue to do so and so she should consider surgery sooner rather than later as it will be a smaller operation with greater probability of success. Currently the patient doesn't feel it is bad enough to warrant surgery.
Radiographs that were provided consist of 3 views of each foot done in a weight bearing position. No fractures or dislocations are noted. Joint spaces appear well preserved. There is no soft tissue abnormality noted. There is a mild hallux valgus deformity of each foot. There appears to be a bipartite tibial sesamoid on the left. The sesamoids appeared to be well located underneath the first metatarsal head. There is some prominence to each medial eminence on the first metatarsals. Although I was not able to accurately measure the hallux valgus angle or the 1-2 intermetatarsal angle these do not seem much greater than values that have been determined in the normal, non-affected population.
Answers to Specific Questions:(5)
1. Is surgery needed?(6)
I do not believe that surgery is needed at this time. Perhaps the primary determinant for undergoing surgery is whether the patient feels that it is warranted given their current set of circumstances. The patient very clearly states that she "...doesn't feel it is bad enough to warrant surgery."
2. What is the recommended timeframe for the surgery?
It is quite possible that she will have worsening of the deformity with concomitant worsening of her pain and decrease in function. If this occurs reassessment of the value of surgical correction should be undertaken at that time.
3. Is it advisable to wait?
4. What are the risks a) if she has it now b) if she waits until she is more symptomatic?(7)
Some of the risks that surgery poses would be present whether it is performed now or in the future. These include but are not limited to wound healing complications, infection, nerve damage, blood vessel damage, failure to achieve correction, recurrence of deformity, joint stiffness, continuing pain and overcorrection of deformity. The complications might differ if she waits until she is more symptomatic if alternative methods of erection including soft tissue/bone fixation are used. These would be specific to the procedure that was used.
5. What other alternatives exist?
The alternatives that exist for the treatment of her problem include comfortable shoe wear with a wide toebox. Although I do not think that any one brand is superior to others I have found that Keen shoes are very effective in providing comfort in patients such as this. They have a large toebox and can be used for many different types of activities/active lifestyles. I would avoid fashionable shoes that have a narrow, tapered toebox with high heels.
In addition to altering shoe wear her current shoe wear might be able to be modified using a ball and ring shoe stretcher. The goal of this device is to stretch out the shoe upper material to better accommodate the medial eminence where most people have pain with hallux valgus deformity. These can be obtained on line for a quite modest price and can be used repeatedly and in all of the patient's shoe wear.
A silicone toe spacer can be placed between the first and second toes to realign the deformity and potentially provide her with some relief.
6. Based upon the history and images, what are your recommendations for the best patient outcome?
Currently, I would pursue non-operative means for controlling the patient's symptoms and to prevent progression of her deformity. If these fail to provide relief she may want to consider surgery when she feels that non-operative methods have been exhausted and that she has no alternative.
I do not advise her undergoing hallux valgus surgery at this time. I think that using the aforementioned non-operative methods could provide her with significant relief and allow her to participate in the activities that she would like to. If the deformity she has progresses and the feet become more painful she may want to consider surgery at that time. Unless there is a worsening of great magnitude in her deformity the surgical correction would not be that much more difficult to perform compared to the surgical procedures that could be considered currently.
Please do not hesitate to contact me in the future if there are additional questions or concerns. Thank you for the opportunity for providing treatment recommendations regarding this patient.
"I did the online consultation because of the drugs that my doctor was recommending as my next course of treatment. The side effects are quite harsh, and I wanted to find out if there were other treatment options available to me. I was very pleased with the results of the consultation in that it both confirmed the treatment proposed and gave me more options."
"Your service was wonderful. The staff's follow-up and follow-through were far superior than what my family received from any facility local to our home. Though the outcome was not good for my father, your superb professionalism and attention to detail were far superior to the care my father had received elsewhere."
"I was extremely satisfied with my POSO case coordinator. She was very caring and empathetic — a great asset to the program. She is an excellent communicator — something you don't always find in modern medicine. Plus, she offered her availability by phone or email should any additional questions come up. I am now much more accepting of my condition and have a more positive outlook, even though it is a degenerative condition."
"The medical opinions that we received from POSO have been critical in enabling us to get the best possible local treatment for a very difficult and aggressive cancer. The professional medical opinions seemed to employ solution-finding techniques that were over and above the standard opinion that we got locally. Our POSO case coordinator was absolutely wonderful in getting the report to us in a critically timely manner. POSO was able to give us some hope when our own doctor had immediately given up and was talking about palliative care. This gave us the specialised medical information, which we could not possibly have obtained ourselves, to look for better treatment options locally. I am so grateful that this service exists."
"It was a great experience. I know that Dana-Farber doctors are the best in the country, but I was unable to travel to Boston for a consultation. We feel much better having our doctor's diagnosis confirmed."
Yes. Having your doctor participate is a legal requirement for a variety of reasons. For example, Online Second Opinions (OSO) must adhere to Health Insurance Portability and Accountability Act (HIPAA) rules and state licensure laws, all of which are designed to protect patient privacy. In addition, many U.S. state laws prohibit the practice of medicine across state lines unless it is between doctors and in the form of a consultative opinion. Finally, many of the reports written by our specialists contain medical terminology, so it is important that your doctor first reviews the second opinion and then discusses its content with you.
Your doctor should not be insulted, as seeking a second opinion is common practice in most countries. If he or she is insulted, you should stress that you are simply trying to gather all the information you need to make an informed decision about your health. It is not always an easy conversation, but one worth having.
The base cost for a medical second opinion is $950. Additional charges apply in certain cases, such as if a formal imaging or biopsy review is performed by our radiologists or pathologists. See this page for more details.
Patients are responsible for all charges, and payment is due at the time of request. Our team cannot file a claim with your insurance carrier or provide a procedure (CPT) code for this service.
Our team includes case coordinators with years of experience recruiting and working with physicians at all Mass General Brigham hospitals. The case coordinators leverage their experience — and physician input — to identify the best qualified specialist based on your medical situation and the questions that you and your doctor submit. This collaboration is yet another OSO advantage.
The first step is to register and enter your credit card information. See this page for more details.
While we make every effort to accommodate requests in these cases, we cannot guarantee that a particular doctor will be available to review your records. Regardless of which doctor reviews your case, you can be confident that he or she has highly specialized expertise.
Yes. Medical translation is a challenging task performed by professional translators who have an exceptional understanding of both medical terminology and the many nuances of the languages involved. Having your records professionally translated helps our specialists provide the most accurate and relevant information possible in their reports—and is critical to ensuring patient safety.
You may send your records to us. However, we cannot proceed with your case until your referring doctor registers with OSO and enters your case.
Our specialists typically complete a second opinion within 10 business days. Our case coordinators will keep you and your referring doctor updated on the status of your consult throughout the process.
You and your doctor may submit questions aimed at clarifying information contained in a second opinion. However, there is an additional fee for follow-up questions. See this page for more details.
You may not do so as part of the OSO consultation process (although when requesting the consult, we encourage you and your doctor to submit questions that you would like the specialist to answer). If you would like to schedule an appointment with the specialist subsequent to the OSO consultation, please contact us. We will be happy to help.
No, as we are not a pharmacy. An opinion may include suggested medications, treatments and/or therapies. However, the patient’s local doctor is responsible for writing all prescriptions.
Roughly 10 U.S. states prohibit the rendering of second opinions over state lines. If you live in one of those states, our website will inform you before you begin the registration process that your case cannot proceed. Our service is not available to residents of countries that are subject to sanctions by the U.S. government.
Yes, although you must fill out a form before doing so. Please contact us for more information.
We try to accommodate urgent requests, but it depends on the availability of our specialists and how quickly we can access your medical records. An additional fee may apply.
Not at this time, although we will introduce videoconferencing in the near future.
Mass General Brigham is a not-for-profit healthcare delivery network based in Boston, Massachusetts. Member institutions include prestigious Harvard Medical School teaching hospitals, including Brigham & Women's Hospital and Massachusetts General Hospital, which co-founded Mass General Brigham in 1994.
Mass General Brigham Connected Health, which manages OSO, is a leading force in the use of technology to deliver care outside of hospitals and doctor's offices. Applying personal health technologies, including remote monitoring, mobile health, personal health trackers and sensors, its people are creating new solutions for empowering individuals and providers to better manage health and wellness.
Yes. Please register with OSO as a physician. After your registration is complete, click “Add a Consult” to proceed.