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Do You Have a Right to a Second Medical Opinion?

Do you have the right to a second medical opinion? Absolutely. You always have the right to get another opinion about your medical care. You can even get third and fourth opinions, especially if that would help you feel more confident about your treatment decisions.

Does your insurance company have to pay for those additional opinions?

The answer depends on a number of factors, including:

  • What type of care do you need? (e.g., surgery, a prescription drug, etc.)
  • What type of insurance do you have? (e.g., an employer plan, a Marketplace plan, Medicare, Medicaid, etc.)
  • Does your insurance plan cover second opinions? (e.g., Medicare covers second opinions for surgery)
  • What state do you live in? Is there a state law that gives you the right to have a second medical opinion covered by your insurance company?

Does your insurance company have to pay for the care recommended by the second health care professional?

Generally, your insurance company will only pay for care from an in-network provider. If the provider that you want to go to is out-of-network, they will usually not pay for that care.

But, there may be times where the care that you need is so specialized that there are a limited number of health care professionals who can provide that care. And, those professionals may not be in your insurance plan’s network.

If it is medically necessary for you to receive that care, you may be able to go out-of-network for that care and your insurance company must cover it.

What if your insurance company says no?

If your insurance company denies coverage for that care, then you can appeal that decision. Learn more about your rights to appeal. It is important to work with your health care team to explain why it is medically necessary for you to receive care from a specific health care professional.

Check out this recent blog from Triage Cancer Legal Advisory Council Member, Cari Schwartz, about a case in California that highlights why it can be important for you to get a second medical opinion.

If you have concerns about the expertise or skills of a particular health care professional or the quality of care that you would receive from that professional, you should seriously consider your right to a second opinion.

For more information about navigating health insurance, visit Triage Cancer’s Health Insurance Topics Page.

About Triage Cancer

Triage Cancer is a national, nonprofit providing free education to people diagnosed with cancer, caregivers, and health care professionals on cancer-related legal and practical issues. Through eventsmaterials, and resources, Triage Cancer is dedicated to helping people move beyond diagnosis.

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