Will Medicare Cover A Second Opinion before Surgery?
This article was updated on: 10/06/2018
What is a second opinion?
When you’re making a critical health decision, you may want a second opinion. A second opinion is where a doctor other than your regular doctor gives her view on your health problem and how to treat it. A second opinion helps you make a more informed decision about your care. Doctors may differ on their recommendations for treatment choices following a diagnosis. According to Stanford Health Care, asking another physician or surgeon for a second opinion is important in ensuring that a particular procedure is the best option for you. According to the American Cancer Society, any type of medical procedure has risks. Generally the more complex the surgery is, the greater the risk of side effects. Side effects of surgery could include but are not limited to:
- Blood clots
- Damage to nearby tissue
- Drug reactions or reaction to anesthesia
- Damage to other organs
A second opinion may help you decide when and if you’ll have surgery. You may also want a second opinion for a major non-surgical procedure. However, if the surgery or procedure is not medically necessary, Medicare generally won’t cover the second opinion nor the surgery or procedure.
How do I find a doctor to give a second opinion?
According to Medicare.gov, you can ask the doctor who gave you the first opinion for the name of another doctor that can give you a second opinion. Your doctor may be encouraging of your desire to get a second opinion and not view it as lack of faith in her own medical advice. You can also can ask another doctor you trust (not the doctor who gave you the first opinion) to recommend a doctor. You also can ask your local medical society for the names of doctors that specialize in your illness or injury. For example, the American Cancer Society website has links to directories of healthcare professionals.
Does Medicare cover a second opinion?
Medicare Part B (medical insurance) may cover a second opinion in some non-emergency cases. If the first and second opinions are different, Medicare may also pay for a third opinion. Make sure that the doctor giving the second or third opinion accepts Medicare. You generally pay 20% of the Medicare approved amount for a second opinion and the Part B deductible applies. If you have an emergency situation, such as an accidental injury, acute appendicitis, a blood clot or aneurysm, don’t wait for a second opinion. You may need surgery immediately.
Do you have more questions about Medicare coverage?
I’m available to help you. You can schedule a phone call or request an email with premium information by clicking the appropriate button at the bottom of the page. To see some plans in your area you may be eligible for, please click the “Find Plans” button.