Wednesday, April 10, 2024

Does Medicare Pay For A Second Opinion

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How Do I Seek A Second Opinion

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Start with your doctor for a recommendation, says Richard Stein, M.D., a cardiologist and director of the Urban Community Cardiology Program in the New York University School of Medicine. Or, if you have one from another source, ask your doctor about this person.

For second or third doctors or specialists, you can also:

  • Ask family or friends whove been treated with the same condition.
  • Get a list of approved doctors from your insurance company or your employers health plan administrator.
  • Contact your local medical society.
  • Look in the American Medical Directory, the Directory of American Specialists or other professional directories at your local library.

How To See A Specialist

Your primary care provider may feel that you have a medical concern that needs to be treated by a doctor who has special training. If so, your PCP can help you find a specialist who can best treat your health condition. You can also use our Find a Doctor or Provider tool to find a specialist.

Any care you receive from a specialist is covered. You do not need a referral to see a specialist.

If you need a printed list of participating specialists, contact Member Relations at 1-800-553-0784 .

People With Any Cancer Diagnosis Can Benefit From Getting A Second Opinion

Second opinions offer different things in different circumstances, Dr. Matasar says. If its a common cancer with a well-established standard of care, they can offer insight into clinical trials or novel treatments that may be better than the standard. He adds that second opinions also can provide insight into topics like clinical genetics and family risk or issues related to complementary or integrative medicine approaches to manage symptoms.

For cancers that are less common, second opinions can offer more treatment options. In circumstances where there may not be a single established standard of care, we can ensure the treatment plan integrates the most current, up-to-date data, Dr. Matasar says. Even if someone is being seen at a different academic center, the trials and other treatment options that we offer here may be different.

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Are Second Opinions Free

Medicare Part B covers second opinions. But your coinsurance still applies. This means youll pay 20% for second opinions, just like you do for any other covered Part B services.

Medicare Advantage plans may have different coverage options. Check with your plan to find out if you can get a second opinion for free.

What To Ask Your Second Doctor

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Once you get the appointment for the second opinion, decide what you want to know and what you hope to get from the appointment. Write down your questions before you go, and take them with you.â

You might have specific questions that are related to your health problem, but some general questions you can ask include:

  • What are my choices?
  • What are the pros, cons, and risks of those choices?
  • Is the diagnosis correct?

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Does Medicare Cover Third Medical Opinions

In some cases, Medicare will even cover third opinions. If the first two doctors didnt agree on your treatment options and youre not sure what treatment is best for you, you can request a third opinion. Think of it as a tie-breaker. Medicare Part B also pays 80% of third opinion appointments.

What extra benefits and savings do you qualify for?

Even If Youve Already Started Treatment Its Not Too Late To Get A Second Opinion

At every step along the cancer journey, theres an opportunity for a second opinion to inform and refine the course of care, Dr. Matasar explains. Patients in the midst of treatment may have questions about how well the treatments working. It can also be valuable to get a second opinion at the end of a course of treatment to figure out next steps for additional treatment or monitoring for recurrence.

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Getting A Second Opinion

When you get a second opinion, its a good idea to arrive with all the necessary information you would need for the second doctor. Be sure your first doctor has sent over all of your medical records, and =put together a list of questions you may have for the second doctor.

During your visit, the second doctor will examine you and review your medical records. Keep in mind, they may order different tests from what the first doctor ordered. In these instances, Medicare will cover the costs of any additional testing you may need.

In some cases, the second doctor will come to the same conclusion as the first doctor. In this case, you can continue with the recommended treatments.

In other cases, the second doctor may give you a different diagnosis or treatment recommendation. Depending on what the second doctor says, you have a few options:

  • You can choose to receive treatment from the second doctor.
  • You can go back to the first doctor and discuss what the second doctor said.
  • You can opt to receive a third opinion from another doctor.

If you decide to opt for a third opinion, Medicare provides the same coverage as if you were getting a second opinion.

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  • Are you sure my diagnosis is correct and is as accurate and precise as is necessary? For many cancers, molecular diagnosis is an important part of matching patients with the best treatment. If youre not sure whether you had molecular or genetic testing or if its important for your type of cancer, you should ask.
  • What is the standard-of-care treatment, and is there more than one option? There may be multiple treatments that offer the same likelihood of success. Its important to understand the pros and cons of each one, including how the side effects of various treatments may differ.
  • What are the clinical trials that are relevant to me both at your institution and elsewhere? Every hospital has its own portfolio of clinical trials, and it may be helpful to understand the full landscape of ongoing research.
  • Do I need to receive treatment here? Clinical trial participation is often restricted to certain hospitals, but an expert at an academic medical center may be able to collaborate with your community oncologist to help you get the same treatment.
  • Can I reach out to you with further questions? Even if you return to your first oncologist for care, often your second-opinion oncologist will be glad to receive updates and offer continuing guidance.

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When Should You Consider A Second Opinion

When a doctor tells you that you have a health condition that requires surgery and its not an emergency you may want to consider a second opinion. A second opinion can help you make a better-informed decision about how to treat your health problem.

Your rights when seeking medical treatment include:

  • The right to know and understand your choices for treatment
  • The right to have another doctor review those choices with you a second opinion
  • The right to participate in decisions on your treatment by making your wishes known

If you need emergency surgery for an aneurysm, blood clots, acute appendicitis, injuries from an accident or any other life-threatening emergency you should not wait for a second opinion.

How Much Do Patients Pay Out

RSOs typically range anywhere between $750 and $2,500. The price variability is mostly dependent on the provider and subspecialty, and from fees associated with follow-up appointments, secondary imaging reads, and specialized pathology reviews. Providers can encourage patients to check with their insurance for full details on their coverage for RSOstheir Health Savings Account and Flex Spending Account might cover some of the cost. Regardless, patients are willing to pay out-of-pocket for RSOs, and there is a growing number of nonprofits that are helping to fill the reimbursement gap for RSOs.

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Is There Enough Time To Wait For A Second Opinion

Treatment decisions should be made after you have learned all you can about your diagnosis, prognosis, and available treatment options. This can take time, depending on the type of cancer you have. In a few cancers, there are some treatment decisions that have to be made right away. But usually, you can take some time to think about them, and you should think about them. If you are concerned about waiting to start treatment, you should talk to your doctor.

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Patients are often under the mistaken notion that they have to pick between their oncologist and MSK, but thats often not the case, Dr. Matasar explains. A doctor at MSK can collaborate with another doctor to offer support and help ensure the best outcomes.

However, there are other cases when a second opinion results in a very different diagnosis or set of treatment recommendations. In those cases, patients are tremendously grateful for having received the advice and encouragement to get a second opinion, Dr. Matasar adds.

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Why You Might Need A Second Opinion

Doctors may have years of extensive training but they are only human. That means they make mistakes. It is estimated that as many as 10 to 15% of diagnoses could be in error. Getting a second opinion could decrease the odds that a diagnosis is wrong or missed altogether.

A 2018 study found that the diagnosis for breast cancer patients seeking a second opinion changed for 43% of the study participants. Second opinions that result in diagnosic changes may affect cancer prognoses as well as treatment plans.

When it comes to treatment, recommendations can differ even if everyone agrees on the diagnosis. In a large 2015 study, nearly 40% of treatment recommendations for study particpants changed after seeking a second opinion.

Seeking A Second Opinion

When youre facing cancer treatment, its normal to wonder if another doctor could offer more information or a different treatment option. You might want to find another doctor who can look at your test results, talk with you about your personal situation, and maybe give you a different take on it. Getting a second opinion can help you feel more sure about your diagnosis and treatment plan.

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Why Seek A Second Opinion

Perhaps youre not feeling confident about your doctors decisions. Maybe youre feeling rushed. Other reasons to get a second opinion include:

  • Your insurance company may require it before covering your treatment.
  • You may have options including not needing the medicine or procedure, or one being less expensive than another.
  • Youre concerned about the risk or how it might affect your lifestyle, family or work.

What If The Second Opinion Disagrees With The First

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Chances are good that the second opinion will be similar to that of your first doctor. If that is the case, you can feel more confident in your diagnosis and treatment plan.

However, the second doctor may have different ideas about your diagnosis or treatment. If that happens, Do not worry you still have choices. You could go back to your first doctor and discuss the second opinion. You may decide together to change your treatment based on this new information. You can also seek the opinion of a third doctor. This could help you decide which of the first two options is better for you.

Keep in mind that even if you get a second or third opinion, you do not have to switch doctors. You get to decide which doctor will provide your treatment.

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What Is A Second Opinion

A second opinion is when you have a doctor review a diagnosis or treatment plan that another doctor gave you.

Second opinions can help you understand your options and make sure youre getting the right care. For example, you might seek a second opinion to see if surgery is really the best option to treat your condition.

Talk with your doctor when you want to get a second opinion. You can ask them to send your medical records over to the second doctor.

Its a good idea to arrive at your appointment prepared with a list of questions for the second doctor. At your appointment, tell the second doctor what treatments or surgery the first doctor recommended.

The second doctor will review your records and examine you. They might order different tests than your first doctor did. Medicare will pay for any additional tests you need.

Sometimes the second doctor will come to the same conclusion as your first doctor. In other cases, you might get a different answer.

There are a few steps you can take if the second doctor gives you a different diagnosis or recommends a different treatment. Depending on what the doctor says you can:

  • Go back to the first doctor and talk to them about what the second doctor said.
  • Get treatment from the second doctor.
  • Get a third opinion from another doctor.

Medicare will provide coverage if you need a third opinion. The rules will be the same as when you got your second opinion.

You May Be Able To Receive A Remote Second Opinion

Depending on where you live, you may be able to receive a remote second-opinion appointment via telemedicine. A physical exam is an important part of care, but a telemedicine appointment can sometimes be an option for a first visit as well, Roxas says. If you live outside the United States, MSKs Bobst International Center can help you schedule an in-person appointment or a remote second opinion.

MSK also has regional sites throughout New Jersey and Long Island and in Westchester County. It may be more convenient to go to one of these locations for a second-opinion appointment than to travel into Manhattan. If you choose to receive your treatment at MSK, much of it may be provided at one of these regional sites.

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How Do I Get A Second Opinion With Medicare

If you have several treatment options, or youre not confident in your diagnosis, you can get a second opinion. All you have to do is ask. Talk to your doctor at your next appointment, and ask them to refer you to another doctor. They can give you a recommendation and send your health records to the second doctor.

When Is A Second Opinion Helpful

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For everyday health care, you probably dont need a second opinion. But a second opinion may be a good idea if:

  • You are deciding about a costly or risky test or treatment, like a surgery.
  • You are not clear about how well a test or treatment may work.
  • You need more information about your options.
  • You are unsure about a diagnosis.

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How To Find A Doctor For A Second Opinion Under Medicare

Before scheduling an appointment for a second opinion, be sure the doctor accepts Medicare. Medicare can help you find a doctor for a second opinion.

You can also ask your first doctor or another doctor you trust to recommend another doctor who can give you a second opinion. Its best to choose a doctor from a different office or practice.

Once youve scheduled your second opinion appointment, youll need to make certain arrangements. This will make it easier and quicker for you to get your second opinion.

Steps to Take Before Your Second Appointment

  • Ask your first doctor to forward your medical records to the second doctor to prevent duplicating any tests or other exams.
  • Confirm with the second doctor that he or she accepts Medicare.
  • Prepare a list of questions and concerns you may have to discuss with the second doctor.
  • Have a relative or friend accompany you to the appointment.
  • If you have a Medicare Advantage plan, you may have to get your second opinion from a doctor in your plans network. If you go to a provider who is out of your plans network, you may have to pay more. Check with your plans administrator to determine what your plan requires.

    What Do I Do To Seek A Second Opinion

    Before you visit a second doctor, have your records forwarded to him or her. Better yet, get a full set and bring them with you.

    Also, be sure to come with specific questions. The more specific your questions, the more focused your meeting, the better the second opinion will be, says Stein, who is also a volunteer for the American Heart Association.

    You should also bring a pad and pen to write down important things, and consider having a significant other to sit and listen .

    When youre done, ask the second doctor to send his notes to you and your doctor.

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    The Nhs : How Do I Get A Second Opinion

    You can ask your GP or another healthcare professional for a second or further opinion . Although you do not have a legal right to a second opinion, a healthcare professional will rarely refuse to refer you for one.

    For more information, see your right to choice in the NHS.

    Do you need a second opinion?Before asking for a second opinion, its worth asking your GP or consultant to go over and explain anything you dont understand.

    If youre unhappy with your diagnosis or would like to consider a different course of treatment, discuss this with them. Your GP or consultant will be happy to explain things and in many cases there may be no need for a second opinion.

    Can anyone else ask for a second opinion?Your family or carer can also ask for a second opinion on your behalf, but only with your consent. If someone requests a second opinion on your behalf, they should have all the information about your illness or condition, and check they understand it thoroughly.

    Sometimes a GP or consultant may ask a colleague to provide a second opinion. For example, doctors may ask their colleagues about a complicated case.

    Second opinion from a different GPIf you would like a second opinion after receiving advice from your GP, you can ask them to refer you to another GP.

    Read the answers to more questions about NHS services and treatments.

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