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A second opinion is the request for an expert to provide an opinion about a diagnosis, treatment or other medical suggestion when you already have an expert opinion.

With a serious diagnosis, second opinions about both the diagnosis and treatment should be considered.  Second opinions are generally covered by health insurance. The Wall Street Journal reported a 2015 study that reviewed 6,791 second opinions. There were changes in diagnosis 14.8% of the time and changes in treatment 37.4% of the time.  A 2006 study reported in Consumer Reports on Health found that a second opinion changed the original recommendations for more than half of the breast-cancer patients.

Do not delay treatment unreasonably while seeking a second opinion or allow a search for certainty to provide a reason for stalling making a decision. There is generally no harm done by delaying start of treatment for a reasonable period of time. Ask your doctor how much time you have to make a decision. To avoid unreasonably postponing getting a second opinion, set a deadline for getting the opinion. 

When thinking about who to ask for a second opinion, keep in mind:

  • In addition to local doctors, you can obtain an opinion from doctors all around the country (or even the globe) or from institutions or services - often without having to travel even if the doctor is in another city. If you do have to travel, free transportation may be available.  
  • A second opinion can come from an expert with the same expertise as the person who gave you an opinion or an expert with a different expertise. For example, if you have an opinion about the need for surgery from a surgeon, it may be advisable to ask for a second opinion from a doctor who specializes in using chemotherapy to treat the same condition.
  • It is generally not advisable to get a second opinion from a doctor who is a close associate of your doctor. Preferably seek a doctor who works at a different institution and was trained at a different hospital and who will review your situation with doctors who have expertise other than your particular doctor's.  With cancer, it is preferable to get the opinion from a doctor who is associated with a Comprehensive Cancer Center certified by the National Cancer Institute (NCI) or an educational institution.

It is advisable to tell the doctor who gave you the original opinion that you will seek a second opinion. 

  • Many people worry that asking for a second opinion will offend their doctor, or effect the quality of care they receive. In reality, these fears are ungrounded. Doctors tend to welcome a second opinion. This is particularly so when the patient has been diagnosed with a serious illness, if the recommended treatment has significant risk, or if there are several treatment options. 
  • Let the doctor know why you're asking for a second opinion. For example: because of the importance of the situation or because you would like to get more information before you make a decision.
  • If you're stuck for what words to use with your doctor, you might choose to begin the conversation with something like: "the information you have given me is so important and involves such major decision making on my part,that I would like to discuss it with another specialist." A competent and compassionate doctor should not object.
  • If it is difficult for you to say "I want" or "I feel I need" then you can suggest that your (fill in the blank with partner, spouse, family etc.) is pushing you to get a second opinion.
  • If asking for a second opinion seems to be an issue for your doctor, let the doctor know you value his or her opinion. Restate your reason(s) for wanting a second opinion.You don't want your doctor to think you are questioning her competence. On the other hand, if seeing a second opinion is a problem for your doctor, it may be good cause to switch to another doctor. (To learn more, see: How To Switch Doctors.)

Keep in mind that a copy of your medical records will be required for a second opinion.

  • If your doctor refuses to make the records available, remind him or her that under the law, you are entitled to a copy of your medical records.
  • If you had a scan such as an x-ray, MRI, PET scan, or CT scan,  or if you had a biopsy, get a copy of the scan or slide - not just a report. The second opinion doctor will likely insist on seeing the original as well as the report. Instead of relying on your doctor's office to arrange for copies of the originals to be sent, you can avoid delays by making the arrangements yourself with the testing facility. (Making a request in person or personally picking up the originals if they cannot be sent electronically may speed the process).
  • Experts advise that:
    • If you are obtaining slides, it is best to have them sent from the original institution or lab directly to the institution or doctor who will give the second opinion. 
    • If information is on film, carry it with you.
    • If information is electronic. ask both the originating source and the second opinion if they can connect over the internet. If not, get the images on a disk and take it with you. 

If you receive conflicting opinions, ask the doctors to talk with each other to resolve the conflict and/or ask for a third or even fourth opinion. A third or fourth or fifth opinion is no different from a second opinion, although it may be more difficult to get an insurer to pay for it. If you can't resolve a conflict, trust your own gut instinct. If you find yourself looking for a third, fourth, or fifth opinion, consider whether you really need more opinions or: Are you really looking for a doctor who will agree with your idea of what you have and what should be done about it? Are you running away from the truth? The answer is likely to become clear when you stop to think about it.


  • If you have health insurance, check your policy. Most plans pay for a second opinion - and even a third and fourth one. Ask your insurance company what your policy covers and if it requires you to see a doctor within that plan. Insurance companies tend not to pay for opinions obtained over the internet instead of in person. 
  • If you have to pay for a second opinion, you may be able to find a specialist who will give an opinion for free if they only have to review facts instead of an entire medical record. Alternatively, you can negotiate the fee and a payment schedule. (If  money is an issue for you, we provide information about dealing with a financial crunch.)

Keep in mind that the final decision is yours. It is your life. Too many people base their treatment decisions on, "because my doctor said so." While a trusted doctor's recommendation can be invaluable, your decision should be based on knowledge combined with your own philosophy, values, and inclination.

For more information, see the following:

NOTE:  If you need an affordable place to stay near a hospital, check offsite link.  The site offers options for patients and their families, from discounted hotel rooms to free apartments.

To Learn More

When To Ask For A Second Opinion

When It Is Advisable To Seek A Second Opinion

It is advisable to seek a second opinion at least in the following situations (Note that this list is to help you work through a decision. It is not meant to be definitive.)

  • Whenever you think you may need one. You know your body better than anyone. Trust your own instincts. For example, if you are told that all diagnostic testing is negative and you are "fine," but you still feel that something is "wrong," seek a second opinion.
  • No treatment is offered. Even if no cure is available for your situation, there may be a treatment that will prolong your life significantly and/or make you more comfortable.
  • A diagnosis is not certain. Your doctor doesn't know what is wrong with you.
  • If your diagnosis is not typical. The standard methods of describing a particular situation do not take into account every single factor that may be relevant. Each of us are unique.
  • You have more than one health condition which might make a "normal course of treatment" unusually risky or potentially more harmful to you.
  • There are several possible treatments and it is not clear which one is best for your situation.
  • If you are considering entering a clinical trial or taking a treatment outside the U.S. ("medical tourism").
  • If the news is very bad, or very good and you didn't expect it. There are times when errors occur, even at the best labs.
  • You are not happy with a recommended treatment and want to know if there are other treatments that could work for you. A second opinion helps assure that all options are considered. Also keep in mind that there are regional differences in the way medicine is practiced. A doctor in another part of the country may have a different treatment to recommend.
  • Before any major procedure such as surgery or chemotherapy.
  • Your doctor is not a speicalist in your health condition.
  • A doctor recommends that you get another opinion.
  • Your insurer requires a second opinion before obtaining treatment. If the company insists, and you don't comply, you may not be covered for the treatment.

When It May Be Worth Your While To Seek A Second Opinion (As above: this list is a general guide. It is not meant to be definitive.

Consider seeking a second opinion in the following situations:

  • Your doctor dismisses your concerns.
  • You are told that there is no hope or nothing else that can be done.
  • You are not getting better.
  • You do not have confidence in your doctor.
  • You live in a rural area and receive treatment at a small rural hospital. (Even if you live in a rural area, today's technology enables you to get a second opinion from afar.)
  • Your condition or symptoms haven't gotten better after a reasonable period of time.
  • You have unanswered questions or feel uncomfortable about your diagnosis or a recommended treatment.
  • You need reassurance that the original opinion was correct and that you have explored all of your options.
  • The recommended treatment has significant risks or side effects.
  • You think there may be other treatments or you are interested in possible treatment options your doctor is not familiar with or with which your doctor doesn't have a lot of experience.
  • You have several treatment options that may involve the expertise of different types of specialists. This situation is known as a "multi-disciplinary" approach because the doctors come from different specialties. (In medical jargon, specialties are known as "disciplines").
  • Your doctor has a financial interest in the test or treatment. For example:
    • The doctor has a financial interest in testing equipment like an MRI or a CT Scan.
    • An oncologist may have a financial interest in the treatment if he or she gives chemotherapy in the office. Giving chemotherapy in the office is a profit center because the doctor buys the drugs and resells them to you.

Sources For A Second Medical Opinion

You can get a second opinion from any of the following sources:

  • A doctor who is board certified in the speciality which covers you health condition or proposed treatment
  • A team of doctors from different specialities (A "multi-disciplinary" second opinion).
  • First-class medical institutions which have both individual doctors and/or teams of multi-disciplinary teams..
  • Medical schools.

You can ger a referral to a specialist to provide a second opinion from any of the following sources:

Primary Care Physician

Ask your doctor for the names of board certified specialists experienced with your diagnosis and treatment. Ask why he recommends a particular doctor, and if he would refer one of his own family members to the individual.

Health Professionals

Ask additional doctors, nurses or other healthcare professionals for the names of doctors who specialize in your condition or treatment. They can often provide valuable "inside" information. They may also be able to tell you about doctors to avoid.


If there is a prestigious or large teaching hospital in your region call their doctor referral service. They will only provide a list of doctors who are affiliated with their hospital, but these types of facilities tend to attract the "cream of the crop." Look for the most prestigious doctor there.

If there isn't such a prestigious or large teaching hospital in your region contact the best such hospitals in the country. Look for the most prestigious doctor.

Medical School

If there is a medical school in your area: Explain the type of doctor that you are looking for and ask for recommendations. Some instructors actually maintain their own medical practices and tend to be informed on the latest recommendations, procedures and treatments.

If there is no medical school in your area: Find out which medical school is the best for your condition and call there. Ask for the names of their most prestigious doctors in your field.

Disease Specific Non-profit Organizations/Support Groups

Both may be able to provide invaluable information because they come to the table with an insight to your diagnosis and medical needs.

Family and Friends

Ask family and friends for the names of doctors with whom they have had a successful relationship, particularly if they were diagnosed or treated for the same condition.

The Internet

There has never been such an abundance of easily accessible information about doctors as can be found on the internet. Unfortunately there is no one stop shopping. The sites described below can help you compare the qualifications of doctors for which you already have names, or help you locate doctors who meet your criteria. All services are free of charge except where noted. (It is advisable to use this information as a tool rather than a decision maker. If a doctor seems to fit your needs, ask him or her why s/he is rated a certain way.)

American Medical Association: "Physician Select" offsite link Provides information on every licensed physician (more than 650,000) in the United States and its possessions. The site also contains "Group Select" which provides information on more than 19,000 group practices.

Health Grades: "Physician Report Cards" offsite link All doctors listed have been in practice for at least two years, are board-certified in their specialty, and have had no Medicare or state medical board sanctions within the past three years.

Web MD: "Find A Doctor" offsite link: Provides information on more than 500,000 doctors. This site also contains provider directories (health insurance affiliation) for more than 300 managed health care plans.

American Board of Medical Specialties: "Certified Doc" offsite link This site allows you to verify that a doctor is board certified in his or her specialty.

  • Historically, second opinions were only available locally or for people who were willing to travel. Thanks to modern technology, second opinions are available from a distant expert or expert center without traveling. In addition to individual specialists, medical institutions and companies of doctors also provide second opinions. You can e mail or overnight medical records, copies of pathology reports, x-rays and other diagnostic tests, as well as a report from your doctor about his or her physical exam.  The doctor providing the second opinion can rely on the physical exam your doctor did or possibly conduct one via video. NOTE: Check your health insurance policy to find out if it will cover a second opinion from a doctor who does not see you in person. Many require an in-person visit before providing coverage.

Once you decide on a treatment, it can be administered by your local doctor if you prefer. 

With respect to cancer: It is preferable to get the opinion from a doctor who is associated with an institution which is certified as a Comprehensive Cancer Center by the National Cancer Institute (NCI) or from an educational institution. You can locate an NCI center by clicking here offsite link. If you don't choose a doctor at one of these institutions, it is helpful if the doctor at least works with a team of specialists who will all look at your case. Team members from different specialties add diffrent points of view. You are likely to find such a team at a large medical center, especially one affiliated with a medical school.  For a list of institutions that  provide a second opinion or a multi-disciplinary second opinion see The R.A. Bloch Cancer Foundation web site offsite link  

How To Arrange For A Second Opinion On A Timely Basis

Time may be short to wait for a second opinion before starting treatment, but even in the most difficult situation, you will probably have at least a few days to get a second opinion. Here's how to do it.

  • Step 1.  As you will note in our section about telling doctors you want a second opinion, it is advisable to let your doctor know you want a second opinion rather than getting a second opinion without letting him or her know. Some patients are needlessly concerned that their doctor may be offended by the request to see someone else. The request should not offend him or her. In fact, most doctors are pleased to receive additional input from a second set of eyeballs. NOTE: It is a red flag if your doctor discourages you from getting a second opinion. See the document in "To Learn More" about red flags and whether to switch doctors.  
  • Step 2. Check your health insurance to find out if you are covered. 
    • If it isn't clear, contact your insurer - preferably through your doctor who may be able to explain the medical reason better. If you will make the call yourself, think about why you want a second opinion. Consider practising asking for a second opinion with the person who handles insurance in your doctor's office. Tell the insurer you need a second opinion, and ask what you need to do to be sure it is covered. 
    • If you have a managed care policy such as an HMO, you may need to get prior approval. For information about speaking with an HMO, and appealing if you are told "no", click here.  
    • NOTE: If your insurance will not cover a second opinion, consider paying for it yourself. It is your life that we're talking about. If money is a problem, see our document about being Uninsured and our document about dealing with what we call a financial crunch.
  • Step 3. Make an appointment with the doctor you wish to consult for a second opinion.
    • If there's a deadline, tell the person who books appointments for the doctor you want to see for a second opinion:
      • That you are seeking a second opinion and
      • That you have a short time frame because you have to make a decision right away.
    • If you can't get a timely appointment, ask your doctor or your doctor's office to call for you.  A call from a medical professional will carry more weight and may be able to shorten the waiting period until your appointment. For example, the doctor you're asking for an appointment may accommodate a request from another doctor by coming in earlier or staying later. 

What To Look For In A Doctor To Provide A Second Opinion

A second opinion should preferably be from a doctor who fits the following criteria

  • Is board certified.
  • Specializes in your diagnosis and its treatment.
  • Has at least as much experience in the condition as your doctor - and preferably more. The more experience the doctor has, the greater the probability of a correct diagnosis and treatment course Board Certification by the American Board of Medical Specialists, in a field directly related to your condition, is a good starting point.
  • Is independent of the doctor who gave the first opinion. Two doctors who are friends or work together are less likely to contradict or "second guess" each other. This may even be the case for two doctors in the same managed care insurance network or doctors who work in the same hospital or treatment facility. This is due to "institutional cultures." Institutional cultures are real, and occur when a respected physician or opinion leader recommends or provides treatment in a given way. Many others at the institution will often conform to the same point of view. At another treatment facility they may have a very different treatment philosophy. (If you have to see a doctor who is not independent of the first doctor, tell the doctor's receptionist when you call for the appointment that you want a truly independent opinion and for the receptionist to confirm with the doctor whether he or she can provide one. You can repeat your need when you see the doctor and judge for yourself whether the opinion will be independent. If it's not, go for a third opinion.)

Check to see if the doctor has been subject to disciplinary action. 

There is no one source to find out if a doctor has been disciplined. In fact, disciplinary proceedings are not made public in all states. That said, consider the following resources:

  • State Medical Board Directors  "Doc Board" provides information on disciplinary action taken against doctors. Not all states participate or are represented on this site, but it is a good start to find out if a doctor has been disciplined. offsite link
  • Federation of State Medical Boards  "Doc Info" is the gateway and federation headquarters for all state medical licensing boards. For a charge of $9.95, the site will provide a physician profile including information on disciplinary actions. offsite link
  • Public Citizen "Questionable Doctors." This non-profit consumer research and advocacy organization was co-founded by Ralph Nader in 1971. For a charge of $20, Public Citizen will provide a list of doctors, by region, who have been disciplined (with explanation) by state medical boards, Medicare/Medicaid, the Food and Drug Administration, and the Drug Enforcement Agency. offsite link

How To Choose A Doctor For A Second Opinion

A second opinion should be from a doctor who satisfies each of the following criteria:

  • A doctor who specializes in your diagnosis and its treatment.
    • A good starting point if Board Certification by the American Board of Medical Specialists in a field directly related to your condition.
  • A doctor who has at least as much experience in the condition as your doctor -- and preferably more.
    • The more experience the doctor has, the greater the probability of a correct diagnosis and treatment course.
  • A doctor who Is not affiliated with the doctor who gave you the first opinion. Two doctors who are friends or work together are less likely to contradict each other.

A doctor's personality and interaction with patients is not generally relevant when choosing a doctor for a second opinion. If it helps, think of this doctor like an automobile mechanic: it is the expertise rather than the personality that counts.

To learn about how to go about the selection process see How To Choose A Specialist. For these purposes, choosing a doctor for a second opinion and choosing a specialist are the same.

Medical Institutions That Provide A Second Medical Opinion

Most first class medical institutions provide second opinions either from a specialist or a team of doctors from different specialties. Some centers ahve second opinion programs where your case is reviewed by a team of specialists from different medical disciplines instead of just one person. (A "multi-disciplinary" second opinion).

Following is a list of some institutions to consider:


Consider getting a second opinion from an NCI certified Comprehensive Cancer Center. For a list, click here offsite link.

For a list of institutions that  provide a second opinion or a multi-disciplinary second opinion see The R.A. Bloch Cancer Foundation web site offsite link  


  • Cleveland Clinic, regarded as one of the top heart hospitals in the country, provides an internet service through "My Consult." For $565, a doctor provides a written second opinion and a treatment recommendation (within 5 to 7 working days of receiving a completed request. It's your obligation to collect your medical records and the other information pertinent to your situation. The Cleveland Clinic is not allowed to provide remote second opinions to patients whose mailing address is in one of the following locations: Guam, Louisiana, North Dakota, California, Nevada and Oregon. People have been known to get around the restriction by using an address in another state of a friend or family member. The eCleveland Clinic MyConsult Remote Second Opinion service is not covered by insurance programs. Many employers have contracted with eCleveland Clinic to provide the MyConsult program as part of their employee benefit plan. For a list of conditions covered, see: offsite link (Note: although most insurers don't pay for electronic second opinions, most insurers would pay for a second opinion if you actually went to the Cleveland Clinic. However, it is unlikely the insurer would pay for travel costs.) offsite link
  • Partners HealthCare Telemedicine (affiliated with Harvard Medical School) offsite link. Opinions are provided directly to the physician rather than the patient. Your doctor provides all the information Partners HealthCare Telemedicine needs. Costs range from $450 to $750. According to Joseph C. Kvedar, director, in 2001, only 5 percent of the diagnoses were changed, but 90% of the treatment recommendations differed from the primary doctor's care plan. The organization is not allowed to provide remote second opinions to physicians in all states.(Note: although most insurers don't pay for electronic second opinions, most insurers would pay for a second opinion if you actually went to one of these institutions. However, it is unlikely the insurer would pay for travel costs.)
  • Georgetown University Hospital offsite link
  • Armed Forces Institute of Pathology serves civilians as well as members of the military and veterans. See: offsite link. Click on "Consultation."

Online Second Opinion Companies

There are online companies that will review your medical records and diagnostic tests. They will then provide a report containing your treatment options and recommended treatment or procedure.

Some of these companies employ leading specialists from some of the most prestigious hospitals across the country. Some are only available through employers and health plans.

The companies charge a fee for their services which is not generally covered by health insurance.

It is advisable to review the credentials of a company and of the doctors they engage before employing their services.

We have not used the following companies, but we understand from reliable sources that each are reputable: (in alphabetical order)

  • Aegis Review was created by a Stanford pathologist, Yale Medical School geriatrician and Mount Sinai School of Medicine medical oncologist and utilizes noted multi-disciplinary oncologists and pathologists. The group provides cancer care diagnostic review and management for the entire cancer experience, from diagnosis through end of life. Aegis Review's focus is limited to cancer. See: offsite link
  • Best Doctors was created by two Harvard medical school doctors. See: offsite link
  • engages doctors at Harvard teaching hospitals. See: offsite link
  • - specializes in cancer treatments. The company includes the services of individual oncologists who practice at hospitals such as Johns Hopkins Medical Center, Yale University of Medicine, Stanford and Memorial Sloan-Kettering. See: offsite link
  • Physicians Background helps locate appropriate doctors or insitutions for a second opinion. See: offsite link
  • Second Opinion Expert, Inc.: SecondOpinionExpert,Inc. offsite link

How To Prepare For An Appointment For A Second Opinion

There are a number of things you can do to maximize the effectiveness of your second opinion.

The following suggestions will help you prepare for, and make the most of your visit.

Step 1: Ask the second doctor's staff or the doctor what specific information will be needed. You may choose to obtain all of the necessary records for your second opinion or you may have your primary care doctor's office supply the information.

Records the doctor is likely to need include:

  • All the medical records from the doctor who made the suggestion for which you're seeking a second opinion.
  • All relevant lab, pathology, and radiology reports.
  • Original tests, not just reports about the tests. This includes pathology slides, x-rays, CT or MRI scans, and ultrasounds.
    • For tests you took other than blood work, the likelihood is your doctor only has reports about the tests - not the actual results. For instance, if you took a scan, the medical record likely has the report of the specialist who read the scan instead of a copy of the scan itself. If there was a biopsy, there would be a pathologists report rather than a slide of a sample. A top notch doctor will want to see the originals rather than a report. A different pair of eyes looking at the same scan or sample may see something different - or the first report may even be wrong. Mistakes happen.
    • If your doctor's office cannot get the originals quickly, call the lab or testing facility yourself. It is not unusual for labs and other testing facilities to ship scans and slides overnight. 
    • NOTE: 
      • Celeste M was told that it would take 5 days before her slides could be sent. When she pressed, she found out that if she went to the lab and waited, they would process the slide immediately and give it to her to overnight to the second opinion doctor's office. 
      • If you haven't determined the identity of the specialist for a second opinion when gathering this information, you hcan have it sent to your address or to another location where someone will be available to sign if needed. You can then forward the material when you have an address.

Step 2: Educate yourself about your diagnosis and current treatments. The more informed you are about these subjects:

  • You will have more of a foundation for asking the right questions.
  • The more precise your meetings with medical professionals will be because you will have more of an understanding of the words they use.
  • You will get a greater understanding of the doctor's advice or recommendations.
  • The better equipped you will be to make tough decisions.

Step 3: Make sure the second doctor's office receives a complete set of the requested information at before your appointment. Ideally the office should receive the information at least several days before your appointment so the doctor has time to review them. Of course this includesoriginals of scans and samples and copies of all of your relevant medical records. 

Step 4: Prepare a list of any questions to ask. See "To Learn More" for lists that you can use as a starting point.

Step 5. Do the normal prep you would do before any appointment with a new doctor. For instance:

  • Make sure your list of medications is up to date so you can give a copy to the doctor.
  • If you haven't already, create a personal medical history form listing your past diseases, operations etc. It will save time completing the doctor's form (or perhaps he or she will allow you to use yours).
  • Get a recorder to record the conversation if there isn't a recorder on your mobile phone. Witha recording, you can listen to what the doctor said more closely at home.
  • Look for a person to go with you to the meeting if possible. We call the person a patient advocate.
  • If you have insurance, be sure to have a copy of your insurance verification card and personal health history form.
  • Review the article, How To Prepare For An Appointment With A Doctor.

NOTE: A good second opinion must be based on an independent evaluation of your condition. If you see a second doctor (instead of working with one long distance), ask for a complete physical exam and evaluation. Doctors can learn a lot from a physical exam.

What To Expect During A Visit With A Doctor Who Gives A Second Opinion

A doctor who gives a second opinion will review all your medical records. The doctor may also give you a physical exam and ask questions to get information that isn't in the records. The doctor may even request additional tests.

Once the doctor feels secure that he or she has all necessary information, he or she will give you an unbiased opinion about your diagnosis, the treatment options available, and the doctor's suggested course of action.

Ask your questions about what the doctor is telling you, or about subjects of concern that the doctor doesn't raise. If there isn't time to cover them all, ask the doctor when you can see him or her again or call with the rest of your questions. (Some people prefer to ask questions in a fax or by e mail

Once you know what the second opinion doctor thinks about your situation: If it differs from what you've been told, ask the doctor about the differences and possible reasons for the differences. Asking after he or she gave an opinion rather than before will help keep the previous doctor's opinion from coloring the thoughts of the second opinion doctor.

You can even ask the doctor to speak with the doctor who gave the first opinion doctor to see if they can resolve their differences.

For more information, see How To Work Effectively With Your Doctors


  • Do not expect the doctor providing a second opinion to discuss the first doctor's competence.
  • Keep in mind that if things aren't clear after getting the second opinion, you can keep going to a third, fourth or even fifth opinion. Just don't let the quest for certainty become an excuse to delay getting treatment. 
  • If you decide that you prefer that the second opinion doctor become your treating doctor, see our information in "To Learn More" about how to switch doctors.

What To Do If There Are Conflicting Medical Opinions

A second opinion that disagrees with the first opinion you receive does not necessarily indicate that one of the doctors is wrong. It simply means they have conflicting opinions.

The field of medicine is not an exact science, and therefore allows for a reasonable difference of opinion. Likewise, there are many times when more than one approach may be effective. The question is which approach works best for your individual lifestyle.

Do not accept the second one just because it is the last one you received or try to decide on your own which is right. So, what should you do when there is even a minimal difference of opinion about your diagnosis and/or recommended treatment? The following steps are recommended:

Step 1. Ask each doctor for their reasoning and source of their advice. Then ask that it be put in writing.

Understanding each doctor's reasoning for his or her recommendation will assist with your evaluation.

  • Is the recommendation based on the latest scientific evidence? If so, on what evidence?
  • Is it based on the doctor's personal experience? If so, what has that experience been? Over how many years? With how many patients?
  • Keep in mind that a doctor's background can have a direct bearing on his recommendation. For example, a surgeon is likely to think primarily in terms of surgical treatments. A research scientist may be most interested in his scientific outcomes.

To assist you in comparing advice from different doctors, ask each doctor to put his or her recommendation in writing, including the pros and cons of the suggested treatment. (An added benefit is that putting tings in writing forces people to hone their thinking).

When comparing opinions, consider the doctor's financial incentives. While money is not the be and end all for most doctors, it may be important to some doctors who are more likely to recommend a specific procedure or treatment if they have something to gain. For example, if you have "indemnity" ("fee-for-service") health insurance, a doctor may recommend a more expensive procedure or treatment, even though a less expensive procedure might be just as beneficial. On the other hand, insurance companies often reward "managed care" plan doctors for recommending a less expensive treatment - even when a costlier treatment may be more beneficial.

Step 2. Show each doctor the other's recommendation and ask questions

Ask each doctor the following question about the other doctor's opinion:

  • What are the points of agreement?
  • What are the points of disagreement?
  • Is there a flaw or weakness in reasoning that may not have occurred to you, or the other doctor?
  • Would another test or exam help clarify the situation?

Step 3. Ask that the two doctors speak directly with each other to discuss your situation and their differences of opinion. (Participate if you want to.)

Sometimes, "two heads are better than one." By working together the doctors may provide each another with valuable insight into your condition or treatment.

If you wish to take part in the discussion, ask the doctors if they have any objections. Many phones can set up a three way telephone conference. If no such phone is available, you can set up a free telephone conference at offsite link (each caller pays for his or her own long distance charges)

Step 4. If necessary, seek a third (or even fourth) opinion.

If after receiving a second opinion you are still unable to make a decision, or if the opinions or recommendations of the two doctors vary greatly, consider taking the time to seek a third (or even fourth) opinion. 

If you would feel more comforatble, enlist the help of someone with general medical knowledge who is not a specialist in the area. The person should be someone with whom you can discuss all youve learned, your concerns, and what's important to you. A good candidate is your primary care physician because:

  • He or she isn't a specialist, so there is no competition with any of the other doctors.
  • There is less likelihood of a pre-formed opinion based on the doctor's schooling or experience in the specialty.
  • The primary care doctor knows you and your life, perhaps even your values.

Also consider speaking with informed friends. Each discussion will help you think of questions, and a different perspective of the risks and benefits of any proposed course of action.

Keep in mind that the final decision is yours - even if you decide that you want someone else to decide. Don't stop until you are satisfied that you understand the situation and are making the best available choice -- one that makes sense to you. If you find yourself looking for a third, fourth, or fifth opinion, consider whether you really need more opinions. Are you really looking for a doctor who will agree with your idea of what you have and what should be done about it? Are you running away from the truth? You'll know the answer when you stop to think about it.

The process of coming to a decision can be difficult emotionally. There are time tested techniques to use to make the wait easier. For instance, keep yourself busy. Access your support system. Exercise.  (For information about dealing with emotions, click here.)

When you are ready, schedule a follow-up appointment with the doctor with whom you want to move forward.

How To Pay For A Second Medical Opinion

Most health insurance pays for a second, in-person, medical opinion.

  • It generally doesn't matter where the doctor is located. 
  • There may be steps you have to take before requesting an opinion in order to have a second opinion covered. 
  • Many insurance policies, including Medicare, require that the patient actually be seen by the doctor. They do not pay for online second opinions or opinions where a doctor just reviews a medical file.

If You Have Health Insurance

If you have medical insurance you are probably covered for the cost of a second opinion, and in some cases a third opinion. In fact many plans require a second opinion before agreeing to pay for major or expensive treatments. Some states even have laws requiring insurance coverage for a second opinion.

Always check the provisions of your policy before obtaining a second opinion. Even if second opinions are covered, there may be details or conditions of which you should be aware. For example, many policies do not cover when patient and doctor do not meet face-to-face.

To learn more, read the following information with respect to the type of insurance you have:

  • Indemnity (fee-for-service) Insurance Coverage: 
    • There are generally no restrictions in obtaining a second opinion. You can see the doctor of your choice. Your out of pocket expense will be based on the provisions of your plan.
    • Consider asking the doctor if he or she will accept "assignment" of your insurance as payment in full. Many doctors are willing to do so upon request, particularly if payment would present an undue hardship for you.
    • To learn more, see Indemnity Health Insurance Policies.
  • Health Maintenance Organizations (HMO's)
    • Most HMO's provide for second opinions at no cost to the insured - with the possible exception of a small co-pay.
    • A referral from your primary care doctor is usually required.
    • It is usually difficult to obtain coverage for a second opinion or treatment outside of your medical group or network plan. If you and/or your doctor feel that this is necessary, be prepared to do battle with your insurance provider. See Health Insurance: Claims: Appeals: Sample Letter: Second Opinion.
    • To learn more, see HMOs.
  • Preferred Provider Organizations (PPOs)
    • Most PPO's cover the cost of second opinions at no charge to the insured - with the possible exception of a minimum co-pay, provided you are seen or treated by one of the doctors from the plans "preferred providers" list.
    • Unlike true HMO plans, PPO doctors usually practice in different offices and are affiliated with different hospitals. Therefore, it may be much easier to obtain a true "objective" second opinion.
    • A referral from your primary care doctor may not be necessary if you choose a doctor associated with your plan network. However, if you see a doctor or receive treatment at a facility that is outside of the network, you will be responsible for a co-pay, which can be very expensive.
    • To learn more, see Preferred Provider Organizations (PPOs).
  • Medicare Coverage
    • Traditional Medicare
      • Medicare Part B covers visits to doctors.
      • Medicare pays 80% percent of the approved amount for a second opinion. Your share is usually 20 % of the Medicare approved amount, after you have paid your $100 annual Part B deductible.
      • If the second opinion does not agree with the first, Medicare pays 80% of the approved amount for a third opinion.
    • Medicare Managed Care Plan
      • Medicare managed care plans (such as HMO's), provide the right to a second opinion from doctors within the plan. Most plans will only pay for a second opinion if you first get a written referral from your primary care doctor.
      • If you want to get a second opinion from a doctor who does not belong to your plan, speak to your plan first. According to Medicare, a few plans may pay for a doctor outside of your plan, but most will not.
    • Private Fee-for-Service Plan
      • If you are in this type of plan, Medicare will pay for a second opinion.
      • If the first two opinions differ, the Private Fee-for-Service plan will pay for a third opinion.
    • To learn more, see Medicare.

If you have to pay for the opinion yourself

If you have to pay, whether because your insurer balks at paying or you are not insured, see if you can negotiate a lower rate for the opinion. Let the doctor's office manager know that you have to pay for the opinion yourself. If the doctor doesn't negotiate individual fees, ask if you can make payment arrangements, such as monthly installments. If you don't get satisfaction from the office manager, see if you can speak with the doctor directly. Staff not have the authority to make such decisions.

If you can't afford a second opinion, many specialists will give an opinion for free if they don't have to take the time to see the patient or review an entire medical record.

  • It's easy to find out how to contact a doctor these days. Doctor searches usually give you contact information. If not, you can usually get an idea of the institutions with which the doctor is affiliated. You can then find out how to contact the doctor through the institution's web site.
  • Ask your doctor to summarize the facts of your situation and give you a copy of the relevant tests or reports. You can then e-mail or overnight this information to the specialist with a request for an opinion.

If you pay for an opinion, you can still go after your insurance company for reimbursement. See Appealing A Denial Of A Request For A Second Opinion.

Managed Care Health Insurance: The Initial Request: How To Appeal A Denial

The Initial Request For A Second Opinion From A Doctor In Your Insurer's Network

If you have a managed care health policy such as an HMO or PPO type of policy, and you desire a second opinion from another doctor within the company's network or medical group, check your plan to determine the circumstances under which a second opinion will be permitted -- especially before surgery.

You may be limited to a choice of doctors or medical groups who are members of or contract with your managed care plan.

Your insurance company may also require a referral from your primary care doctor before allowing a second opinion.

If you desire to obtain an opinion from a doctor who is not in the network or medical group, it has been our experience that you will fight an uphill battle to have the insurer pay for the second opinion. The company not only has to pay the charge, but the charge is not discounted like the ones they negotiate with their own doctors. However, it is worth the effort to try to obtain the opinion from the doctor you want.

If time is of the essence, (for instance, a situation may become inoperable if it is allowed to continue), and you are denied the right to get the second opinion you want, consider obtaining the second opinion, paying for it yourself, and then appealing the decision against your insurance company,

The Initial Request For A Second Opinion From A Doctor Not In Your Insurer's Network

If you have a managed care type of policy, it is likely that you will fight an uphill battle to have the company cover the second opinion. HMOs don't like to refer members to doctors that are not part of the network because they not only have to pay the charge, but the charge is not a discounted fee like the ones they negotiated with their own doctors. However, it is worth the effort to try to obtain the opinion.

  • Step 1. Determine whether the restriction against going to outside doctors for a second opinion is regulated by the medical group or the HMO.
    • Ask your doctor or your doctor's office manager. Also ask to whom you should appeal. Don't be surprised if you are told to appeal to the Referral Committee at the medical group. If such a committee exists, it is the group that is in charge of deciding when to refer patients to other doctors, and if so, to whom.
  • Step 2. Confirm the next step with the HMO.
    • To avoid going down the wrong alley, call your representative at the HMO and ask to whom you should appeal the decision. The company may permit you to appeal directly to the company and override the medical group's decision. Or the company may tell you the decision can only be reviewed once the medical group has turned you down.
  • Step 3. Prepare your facts.
    • Your appeal needs to present evidence with as many medical reasons as you can find that justifies the expense of the second opinion. This will require some planning and some research. Hopefully, your doctor may help. Even if she does, you may wish to search medical resources for help. Your national or local disease specific non-profit organization may have specific information that will assist with your appeal.
    • Look for an objective reason for a second opinion that a third party can understand. For example,
      • Is it the recommended treatment unusual for your diagnosis?
      • Is there a pattern of overuse of this particular procedure?
      • Are there less invasive alternative treatments?
      • Are there treatments that have had a better success rate?
      • Are there treatments that should be explored which are cheaper?
      • Is there something about your condition or the rest of your health that makes a second opinion especially important?
    • Explain why the second opinion has to be provided outside the network
      • In addition to confirming the need, you want to explain why it's important that someone render the opinion with no ties to the doctor recommending the procedure. For example, with cancer, a medical oncologist may recommend a different procedure than a surgeon.
      • As stated above, the only way to assure an independent opinion is to meet with a doctor who is not influenced by the strategies used by the HMO or the medical group.
  • Step 4. Appeal.

How To Appeal Denial Of Coverage For A Second Opinion From An Out Of Network Doctor

  • Explain Why A Second Opinion Should Be Provided Outside The Network
    • Explain why it's important that someone render the opinion with no ties to the doctor recommending the procedure. For example:
      • Doctors who work together or even in the same locality tend to have similar recommendations.
      • You have research that indicates there is more success with a particular procedure that no one in the network specializes in.
      • The only specialist in a procedure that has not been recommended, but seems promising, is not in the network.
  • With These Thoughts In Mind Draft Your Appeal Letter
    • Start by specifically stating what you are appealing. Include what the request was, to whom it was made, who turned it down, and when.
    • Present your arguments together with any documentation you find.
    • Close by restating the specific request.
    • Get your letter to the company within the time period required by your policy for an appeal.
    • For an example of a letter appealing a request for a second opinion, click here.

What If My Doctor Insists That My Second Opinion Has To Come From Another Doctor In The Same Medical Group?

If your doctor tells you that the only second opinion you can obtain under your health insurance plan is from a doctor in your own doctor's medical group, consider appealing the decision. As noted elsewhere, the main value in getting a second opnion is the doctor's independent judgment:

Step 1. Find out whether the regulation saying you have to get a second opinion from your doctor's medical group is a rule set by the medical group or by your insurance company.

You can ask your doctor or your doctor's office manager. If you don't get a straight answer, ask to whom you should appeal. If you are told to appeal to the Referral Committee at the medical group, it's the doctor's group instead of the insurer that decides when to refer patients to doctors outside the plan.

Step 2. Confirm the next step with the insurer.

To avoid going down the wrong alley, call your representative at the insurer and ask to whom you should appeal the decision: can you appeal directly to the insurer or do you have to appeal within the medical group first?

Step 3. Appeal.

See: How To Appeal A Decision Denying Payment For A Second Opinion.