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Second Opinions 101

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

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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.

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