Key takeaways:
You have the right to seek a second opinion for your medical diagnosis and treatment.
Your health plan may ask you to get a second opinion before you have major surgery or start cancer treatment.
Your health plan may cover all or most of your cost for a second opinion.
When you make a major life decision like buying a house or changing jobs, you probably look at more than one source for information. The more information you gather, the more informed you are to make the decision.
It’s no different in healthcare. You have the right to gather as much information as you can before making a major medical decision. And your rights include getting a second opinion.
A second opinion is when a healthcare provider other than your regular provider reviews your medical records and condition in order to diagnose and treat you. Their opinion may be the same as your regular provider’s or it may be different.
Getting a second opinion is common, and your provider shouldn’t have a problem with it. In fact, some providers recommend it to their patients. Learn when you should ask for a second opinion, how to prepare for your appointment, and what to do if you still have questions or concerns after your visit.
When should you ask for a second opinion?
You don’t need a compelling reason to get a second opinion. Let’s say your provider understands your concerns and has answered all of your questions, but you want to explore other options. It’s time to get a second opinion.
Here are some reasons for getting a second opinion:
Your provider suspects what’s wrong, but isn’t sure.
You want to learn about other treatment options.
Your diagnosis is rare or unusual.
You want a specialist to weigh in on your diagnosis and treatment options.
You’ve read or heard about other treatments that your current provider isn’t offering.
You don’t understand your provider and want to try talking to another provider.
You want to weigh all the risks and benefits of your treatment options.
According to one study, a second opinion affected treatment plans for 37% of patients and changed diagnoses for almost 15%.
Are there situations where you shouldn’t ask for a second opinion?
If your condition is life-threatening and you need emergency care, you shouldn’t seek a second opinion. You don’t want to delay a lifesaving surgery or treatment to get a second opinion.
How do you prepare for a second opinion appointment?
Being prepared for a second opinion appointment is important. After all, you’re meeting with a provider who doesn’t know you, your medical history, or your current diagnosis. Make sure you tell their office that you’re coming in for a second opinion and ask what medical records you should deliver to them in advance.
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Also, bring a folder with the following items to your visit, if you have them:
Test or biopsy results
Surgery reports or a discharge plan if you were in the hospital
Your current provider’s treatment plan
A list of your prescriptions and over-the-counter medications
A list of questions
What should you do if you aren’t satisfied with a second opinion?
After getting a second opinion, you may still have questions or concerns. You may feel confused, especially if the provider goes completely against what your first provider said. If that’s the case, you have more options:
Talk to both providers about their opinions and treatment plans. See if they can review your case together to reach a consensus.
Take all the information you’ve gathered to another healthcare provider for a third opinion.
Schedule a telehealth (virtual) visit with a healthcare provider to review your case. Some telehealth companies specialize in second opinions.
What are my rights for a second opinion?
As a patient, you have rights, and those rights include getting a second opinion. Consider the following information about second opinions before you schedule an appointment.
Are you legally entitled to a second opinion?
You have the right to seek a second opinion because you have the right to be in charge of your medical care. Some insurance plans may even require a second opinion before you have major surgery or start cancer treatment. Ask your insurance company before seeking a second opinion.
Do you need a referral for a second opinion?
It’s a good idea to talk to your insurance provider before getting a second opinion. Some may ask you to get a referral from your primary care provider. Others may give you the go-ahead and simply ask you to stay within your network. It’s all up to how your health plan is set up for second opinions.
Can a provider deny your request for a second opinion?
Yes, a provider can turn you down, but this is very unlikely. Most healthcare providers today understand your right to a second opinion per the American Medical Association’s Code of Ethics. But if you don’t need their referral, you can still seek a second opinion.
If you do need their referral, talk to your insurance provider about the situation. They may tell you to go ahead and get the second opinion without the referral. They may also call your provider and ask for the referral.
Can you get a second opinion for free?
The cost of a second opinion depends on your health plan. Always talk to your insurer before getting a second opinion to avoid any billing confusion and clarify your network coverage. You may need a referral and/or to see an in-network provider for coverage.
Your plan may cover all or a portion of your visit. In fact, Medicare pays 80% of the Medicare-approved amount for services. That would leave you paying 20% after you meet your deductible.
The bottom line
You don’t have to feel rushed to make a major medical decision. If after talking to your healthcare provider you still have questions or concerns, you have the right to seek another provider’s opinion.
Many providers welcome their patients to seek second opinions and encourage them to gather as much information as possible before making a major medical decision. Just remember to talk to your health plan first and understand your out-of-pocket cost (if any) for a second opinion.
Why trust our experts?
References
American Cancer Society. (2019). Getting a second opinion.
American Cancer Society. (2019). Seeking a second opinion.
American Medical Association. Patient rights.
Centers for Medicare & Medicaid Services. (2020). Getting a second opinion before surgery.
Cigna. (2021). Getting a second opinion.
Myer, A., et al. (2015). Evaluation of outcomes from a national patient-initiated second-opinion program. The American Journal of Medicine.
Patient Advocate Foundation. (2008). Second opinions: Know your rights and options.
