Seeking Second Opinions With Health Insurance

Posted: August 23, 2023

Seeking a second opinion may help reassure you about your diagnosis or explain your symptoms better. Looking for a different doctor’s opinion is very common and can make the diagnosis process more manageable and help you move forward with confidence. Explore what a second opinion means and whether health insurance covers it.

What Is a Second Opinion?

A second opinion occurs when a patient does not immediately accept a medical diagnosis. Many diagnoses may be hard to accept, especially those that imply a low quality of life or a reduced life expectancy. Sometimes, you may trust your doctor but would appreciate another look to be entirely sure. A second opinion offers peace of mind and helps you trust in the prescribed treatment and management of your condition.

Consider a second opinion if you:

• Receive a rare diagnosis: In some cases, you may be diagnosed with a unique or very rare condition that needs a second opinion to confirm whether the diagnosis is accurate.
• Need more information: Some health care providers require more details before officially diagnosing a specific condition.
• Want another opinion: Your doctor or yourself may want another opinion before confirming the diagnosis is correct.
• Have been diagnosed with cancer: Cancer often requires a second opinion, and insurance agencies may even require it before treatment can begin.
• Need surgery: In some cases, certain surgeries may require a second opinion to be sure it is the best option for your health.
• Receive an experimental treatment recommendation: Some cancer treatments may be experimental, meaning a second opinion by another specialist is required before treatment can begin.

A doctor may diagnose a serious illness, recommend life-changing surgery or offer treatment for your condition. Whatever the case, it’s important to make the best decision for you and your wellness. A second opinion could eliminate the need for unnecessary procedures, or help narrow down specific treatment options that would be a better fit for your needs.

Finding a doctor for your second opinion can be challenging. Understanding whether your health insurance plan covers a second opinion can ensure you are making the right decision.

Does Medicaid Cover Second Opinions?

Both Medicaid and Medicare insurance plans often cover second opinions from a doctor or specialist, including in-person visits and consultations. Some plans may require a second opinion based on your illness or condition. Some Medicare plans may pay for a third opinion as well as a second opinion, depending on how differently the diagnoses vary.

In many cases, patients with a lower income or those in less populated areas may have reduced access to second opinions or specialists. Those with better financial access may receive faster treatment and second diagnoses. Consider all your options and resources before dedicating yourself to a second opinion. Check that your insurance agency or primary care physicians are willing to help you find and locate the right doctor for your needs.

How Does Insurance Handle a Second Opinion?

How your insurance company handles a second opinion request may depend on its specific costs, fees and coverage rules. Insurance companies may cover second opinions for certain medical conditions while denying coverage for others. Your out-of-pocket costs may also be higher depending on whether you see someone outside or inside your network.

Some insurance companies may actually require a second opinion depending on your specific condition. For example, if you’ve been diagnosed with a unique or life-threatening illness, your doctor may require another opinion to ensure the diagnosis is correct. Conditions like cancer or extreme surgery may also call for a second opinion.

In all cases, it’s essential to contact your insurance agency. They can assist you with finding the right doctor for a second opinion. If your primary care physician has requested another opinion or your insurance agency requires it, they will work with you to find a physician or specialist. Your insurance agency will also let you know what is covered under your policy.

How Does Billing for Second Opinions Work?

Billing needs and costs for second opinions vary between different insurance agencies and providers. You can often choose between a virtual second opinion and an in-person second visit. This works for those who only want a consultation before visiting the doctor for a diagnosis. A virtual and in-person visit may lower your expected bills and fees, especially if your insurance doesn’t cover a second opinion.

For second opinion visits in the United States, in-person visits often cost several hundred dollars. This will vary depending on the diagnosis you receive, tests your condition requires, or consultations needed with other professionals, doctors and specialists.

Most insurance companies will cover the cost of a second opinion doctor visit, but the cost of treatments or tests will vary. Finding a second opinion may also take longer, resulting in extra out-of-network costs for seeing a doctor.

Can Insurance Deny a Second Opinion?

In most cases, insurance companies will not deny a second opinion. The second opinion is protected under Medicare and many insurance companies. Make sure you ask specific and detailed questions to your insurance agency before requesting a second opinion in the case of extra fees or the chance of denied coverage.

While an insurance company may not deny a second opinion, certain aspects like treatments or tests may not be fully covered by your plan. It’s best to check whether your insurance agency covers all parts of a second treatment to determine whether it will be worth the time and money.

Explore Plans With Help From Health for California

Since 2004, Health for California has assisted California residents with finding the best health insurance plans to fit their medical needs. Our agents — licensed with Covered California and the California Department of Insurance — have the knowledge to provide excellent customer service and valuable health care information.

We want applying for insurance to be easy. We guide you through the application process and offer a quick quote to help you find the right plan for your needs. Other services include cost-sharing qualification assistance, calculation of government subsidies and health care budget considerations. Contact us today to speak to a representative or shop for different plans online.