Do Insurance Plans Cover Second Opinions in Medical Decision-Making?

Seeking a second opinion from a doctor can be an important part of healthcare. Physicians are highly trained, but like any professional, they sometimes make mistakes. In fact, diagnostic errors occur in up to 15% of cases. That said, you should always feel empowered to seek a second, outside opinion if you are worried that you're part of the statistic.

Second opinions play an important role in medical decision-making, especially when you are preparing for an expensive or risky treatment or surgery, are unclear about how a treatment will work, need more information from your provider, or are questioning your diagnosis. They can help you make more informed medical decisions and learn your medical treatment options. They can also make you feel better cared for if your doctor isn't a specialist in your condition or if you don't communicate with your doctor well and want to find a physician who makes you feel cared for.

If you want to get a second opinion but feel like you face a roadblock when it comes to understanding health insurance and whether it will cover your appointment, you're not alone. In the next section, we'll talk about the ins and outs of second opinions and health coverage and hopefully put your mind at ease.

Does Health Insurance Cover Second Opinions?

The good news is that most health insurance plans cover second opinions. However, a few details might affect whether your secondary visit is covered or not: seeking a second opinion purely for the purpose of getting a prescription, doing virtual visits instead of in-person (if your insurance doesn’t cover virtual visits), or making the appointment with an out-of-network doctor.

The following tips can further help you ensure you get the covered, high-quality, and valuable second opinion you need:

1. Ask your health insurance company whether it covers second opinions.

If you are unsure about your medical treatment options, speak with your doctor about your concerns. If you still have questions and need more information to feel comfortable and confident in your medical decision-making, call your health insurance company and ask whether it covers second opinions for a specific procedure, treatment, or surgery. And ask for the requirements to ensure it will be fully covered.

2. Try a new referral from your primary care doctor.

Depending on your plan, you might need a referral from your primary care physician in order to see another doctor. All you have to do is ask your doctor who they recommend in their network of experts. Make sure to also ask them whether their recommended provider is in your health insurance network to reduce out-of-pocket costs.

3. Schedule a visit with your second doctor, and send them your medical records.

In order to get the most helpful second opinion from a doctor other than your own, remember to send your medical records and the original doctor's opinion to the secondary provider. They will need plenty of background information to offer an educated evaluation of your options. This information should include biopsy or surgery reports, hospital discharge reports, test results, imaging results, and details about any drugs or supplements you take.

4. Take notes during the appointment, and have the second doctor send a report to your original one.

Taking notes and keeping track of your records helps you address all of your concerns and also provides your original provider with the results of your second visit. Chances are that you're not going to remember everything you want to ask offhand in the doctor's office, so it's a good idea to write your questions down prior to your appointment with the second provider to ensure you really do get the information you need.

All of that said, if your insurance won't cover a second opinion, you might be able to use a Flexible Spending Account (FSA) or a Health Savings Account (HSA). You can also consider seeking that second opinion through virtual care. The process doesn't always have to involve a face-to-face meeting with a new specialist if a virtual care provider is willing to examine your medical records, clinical notes, imaging, lab results, and procedure history to inform their opinion. Virtual care providers can offer a more affordable way to get a second opinion, especially for those seeking that opinion for minor issues, like prescriptions or treatments for less serious conditions. Plus, the conversation can be had from the comfort of home.

Seeking a second opinion might seem intimidating, but it can be a hugely valuable part of your healthcare. Talk with your primary care doctor and insurance provider about your options today if you think you're ready to take that step.

At Health Karma, we believe that good healthcare starts with understanding it. To learn more about getting the care you need, click here.