When you're in the market for a second medical opinion, where you turn depends on what kind of insurance you have.
The question usually arises after your doctor has recommended surgery. If you have doubts, a second physician can either confirm the first one's advice or offer an alternative plan of treatment.Here's how the second opinion is treated under the major types of health coverage:
- FEE FOR SERVICE. Increasingly, in traditional, fee-for-service health plans, getting a second opinion before surgery is a requirement. Neglect to do so and you could end up paying a flat penalty - say, $500 of the surgical bill - or a 50 percent co-payment instead of the usual 20 percent.
If the second doctor disagrees with the recommended procedure, the insurer will likely pay for a third opinion.
- MEDICARE. Medicare does not require second opinions but will pay for them as for any other doctor visit, at 80 percent of the approved rate.
- MANAGED CARE. Because doctors in managed-care plans must abide by review procedures for elective surgeries, second opinions are less prevalent. But plan doctors will refer you to another doctor in the network if you ask them to.
To improve your chances for independent advice, suggests Rhys Jones, author of "The Ultimate HMO Handbook" (TTM Health Publishing, $7.95), consider asking the plan management, rather than the doctor, for the referral.
If you seek advice from an out-of-network doctor, generally you'll pay the bill, unless you can convince your insurer that in-house doctors lack the expertise to deal with your condition.
If you've joined a so-called point-of-service plan, however, you can go outside the network with only slight reductions in coverage.