American Heart Association offers guidelines
The San Francisco Chronicle
When it comes to serious medical conditions, getting a “second opinion” is often not only a good idea, it can be a requirement.
Health insurers will, in some cases, insist on a second opinion before they’ll agree to pay for an unusual or particularly expensive medical procedure.
The investigation of two heart specialists in Redding was triggered when patients who were told they needed immediate heart surgery took the time to ask other doctors to look into their cases. The second look showed the surgeries weren’t needed.
In a more typical situation, consumers may demand a second opinion because their doctor — or their health plan — is not willing to approve an operation on the grounds it is “medically unnecessary.”
The American Heart Association advises patients to seek a second opinion in many circumstances:
— If the treatment your doctor recommends has “significant risk.”
— If you feel rushed to make a decision and want more information.
— If the treatment will greatly affect your lifestyle, your work or your family.
— If you don’t have full confidence in the treatment or the doctor.
“Don’t worry about hurting the doctor’s feelings when you ask for one,” the Heart Association advises on its Web site, http://www.americanheart.org.
Most California consumers are covered by managed care health plans, i.e. HMOs. State law gives patients in HMOs the right to a second opinion, but the HMO can require that it be provided by a qualified physician in the same medical group.
The HMO must pay for that second opinion, although patients may be assessed the standard co-payment fees. If patients want a second opinion from outside the medical group that is handling their care, they may have to pay for it themselves. If there is not a qualified doctor within their medical group able to give that second opinion, then their HMO will have to pay for it.
Details about second opinions in HMOs are included in “The California Patient’s Guide,” developed by the Foundation for Taxpayer and Consumer Rights and available through the California Department of Managed Care at http://www.calpatientguide.org.
