What Medicare Will And Will Not Cover
Medicare will pay for a second opinion and sometimes a third if the first and second opinions do not agree. Think of it as a tiebreaker.
What Medicare will not do is tell you which provider to pick in the end game. The final decision is yours to make. You can go back to the original provider or continue care with the second opinion provider.
If you choose to pursue surgery, Medicare will then decide whether or not to cover it. That’s right. Just because one, two, or three doctors recommend a procedure does not mean that Medicare will pay for it. Medicare requires that a procedure be medically necessary according to their standards. Of note, Medicare does not cover cosmetic surgery or procedures it considers to be experimental for this reason.
Medicare often does not pay for repeat testing either. For example, if Ms. Jones had a mammogram, that same mammogram will need to be reviewed by the new consultant. Medicare may not see the medical need to repeat the mammogram for the new doctor to make a decision. Studies not previously ordered in the original evaluation, however, may be covered if Medicare sees them as appropriate.
Before You Arrive At Your Appointment
Before your appointment, you will need to gather medical records, reports, and scans. Please work with your physician to collect copies of these files. You will need to sign a release form to obtain the information. We will have access to any tests or reports that were performed at the hospitals of Lee Health.
It is essential that our physicians have this information available at the time of your visit so they can provide the most accurate opinion on your care during your appointment.
- Medical records, including all previous surgical and other procedure reports
- Pathology slides and reports. These are glass slides of tissue that has been biopsied, as well as the written reports by a pathologist. Pathology reports and slides will be returned after our physicians review them.
- Actual films or CDs of scans. These include:
- Bone scans
IMPORTANT: Our schedulers will instruct you on where to send records or if it’s best for you to bring these items to your appointment.
When Is A Second Opinion Helpful
For everyday health care, you probably don’t 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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Doctors Opinions May Differ
A different doctor may come up with a different diagnosis, or at least offer a different opinion as to treatment choices. Not every doctor will have the same opinion with regard to diseases and possible treatments. Factors which may have an effect on a doctors opinion are technology available to that doctor, school of thought, where they were trained, individual methods of treatment and experience in dealing with that particular diagnosis.
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.
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Questions To Ask Your Eye Doctor
When you visit the doctors for their expert opinions, be sure to ask these questions to compare:
1. How serious is my eye condition?2. What are the different treatment options?3. What is the best treatment option for my particular case?4. What are the risks that come with this treatment option?5. What happens if I dont receive treatment?
Also, consider seeking the second opinion from a completely different institute. Different eye health clinics will have different approaches to eye care. When getting a second opinion, feel free to bring along any rest results and information gathered from the first consultation. Be open about what the second consultation is about: getting another appraisal.
What A Second Opinion Involves
Medicare will pay for a second opinion when you are facing a medical surgery or a major therapeutic procedure. This does not mean the evaluation is free. You are still subjected to the 20% Medicare Part B coinsurance you would pay for any other outpatient medical care.
Specifically, Medicare will pay for a board-certified physician to review any existing data in regards to the medical condition in question. Additional information may also be sought, including a physical examination and, in some cases, additional tests.
A thorough second opinion evaluation will review your medical information, confirm the accuracy of a diagnosis, establish a prognosis, and review available treatment options whenever possible. This may or may not involve multiple providers. For example, a pathologist may review a biopsy specimen to verify a diagnosis while a surgeon may discuss different treatment approaches for that condition.
For clarification, a second opinion refers to evaluation by a doctor in the same field of medicine. A family physician referring you to an oncologist, for example, is not considered a second opinion. Consultation with a second oncologist for the same medical problem, however, would be.
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Stanford Medicine Online Second Opinion Program
The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. If you have received a diagnosis or recommendation for treatment and want another opinion, our service can help you make a more informed decision.
Getting a second opinion from us is easy, convenient, and all done remotely. You dont have to visit our hospital or one of our clinics for this service. You dont even need to leave home!
Looking for a second opinion for a child? Visit Stanford Childrens Healths online second opinion page for more information.
But First What Is A Cataract
A cataract is a type of eye condition that causes cloudiness within the lens of the eye. This cloudiness will interfere with a persons ability to see. A cataract can result in blurry vision, faded colors, halos, and in some cases, blindness. Cataracts can be the result of aging, blunt force trauma, radiation exposure, or genetic diseases. If you dont trust a diagnosis you received from your previous doctor, get a second opinion from a different eye doctor before you determine whether or not to get a cataract surgery or treatment.
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Why Get An Online Second Opinion
- Assurance: Many cases reviewed result in a revision of diagnosis or change in treatment plans
- Convenience: Receive a online second opinion from an expert at Massachusetts General Hospital without traveling to Boston
- Speed: Comprehensive, expert opinions are provided within two weeks of receiving all of your records
Getting A Second Opinion On Your Pathology Report
Most people believe that pathology reports are always correct, accurate and that what the report says is carved in stone. This is not true.
Pathology reports are subjective. They are not objective. Pathology reports are the opinion and interpretation of the individual pathologist viewing the tissue samples. It is not uncommon that two different pathologists looking at the same slide come to a different interpretation and opinion about what is in their microscope!
Good pathology readings require experience and a high level of expertise. Some specialists have more expertise and more experience than others.
Some pathologists have more experience than others. Some specialize in reading only slides that come from a specific organ while others are generalists who read many different pathology slides from many different organ systems.
When you review your pathology report and are going to be making important decisions, like treatment decisions, which will be based on the information from the pathology report. Best practices dictate that you obtain a second confirmatory pathology evaluation. Obtaining a second opinion on your pathology report is no different than getting a second doctors opinion, it is a must for all of us.
The more accurate the information we have, the better our treatment decisions.
Remember if you ship them include the following information:
1- Your name
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How To Start Your Second Opinion Virtual Visit
To start the process of requesting a second opinion virtual visit, simply fill out the form below. Once your completed form is received, you will be contacted within 2 to 3 business days.
NOTE: Depending on your location, state laws on the practice of medicine may prohibit second opinion virtual visits. In the event we are unable to provide you with a second opinion virtual visit, our team would be happy to assist you with scheduling an in-person appointment.
When Should You Ask For A Second Medical Opinion
Its important for you to feel comfortable with the prognosis and treatment your doctor provides you. If youre feeling uncertain about a treatment plan or even a diagnosis from your doctor, you should seek a second opinion. Getting a second opinion can be a good idea when:
- Youve been diagnosed with a rare condition
- Youve been diagnosed with cancer
- Your doctor recommends surgery or other high-risk procedures
- Youve been on a treatment plan for a long period with no improvement to your condition
The exception to this is during emergencies. If youre currently experiencing a medical emergency, you should get care from the doctor thats currently treating you. Dont wait to get a second opinion if your doctor says you need surgery for something like a blood clot or some other critical condition. It’s critical that emergency operations are performed as soon as necessary to protect your health.
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Getting Ready For The Appointment
Before you go to the appointment to get a second opinion, gather all of your medical records related to cancer. This includes test results, such as blood work and/or imaging tests. The doctor giving a second opinion will probably ask for the results of any tests or procedures you already had. Ask the second doctor’s office if any test results, imaging scans, or other medical information needs to be sent ahead of time, before you have your appointment. This can keep you from having to have these tests again. Cancer.Net has several medical forms you can download to keep all your information organized.
Here are some tips for how to get all the information you need during the appointment:
Take notes. Ask the doctor if you can record the appointment. Writing down notes or recording the appointment can help you review the information later.
Take someone else with you. They can help you take notes and remember what and the doctor talked about.
Ask questions, especially if the doctor says something you do not understand. It is important to have the information you need to make the best decisions about treatment.
Getting a second opinion will help you feel more empowered and confident in your treatment decisions. It is important that you receive cancer treatment you understand and are comfortable with, and a second or even a third medical opinion can help you do that.
Does Medicare Pay For A 2nd Opinion
So will Medicare cover second opinions? The good news is that Medicare covers most second opinions. This helps you make an informed decision about your treatment options. Both Medicare Part B and Medicare Advantage plans cover second opinions.
Before you book a second opinion, make sure the second doctor accepts your Medicare coverage. Your plan only covers second opinions from in-network providers.
We’re Available Every Step Of The Way
When given a serious diagnosis or treatment plan, it is helpful to have as much information as possible. Getting a second opinion can be a vital part of making a decision about your care or the care of a loved one. Lee Physician Group can provide a second opinion from experts in your condition when your care decision matters most. Our care team will be available every step of the way to help you through this process.
Situations Where A Second Opinion May Be Important:
- You have a rare or unusual cancer
- You feel uncomfortable with your doctor, the diagnosis or you need confirmation
- Your health insurance requires it
- The treatment offered has side effects or risks that you find disconcerting
- The treatment options will result in unacceptable or unreasonable demands on your life and your family
- Your doctors treatment goals are different from your own
- Your cancer is not responding to your current treatment
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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.
Does Medicare Advantage Cover Second Opinions
While Medicare Advantage must cover everything that Medicare covers, it can vary in how it covers it. Plus, since most Medicare Advantage plans are HMOs, you may have to be approved by your primary care physician before seeking a second opinion from a specialist.
For further questions call a Senior65 agent at 800-930-7956.
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What To Ask Your Second Doctor
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?
How To Go About It
Will your doctor mind?
The right for patients to participate in health decisions is one of the key rights specified in the Australian Charter of Healthcare Rights. That includes getting a second opinion when there’s any uncertainty, to help patients make informed decisions and give informed consent.
In theory, then, doctors should welcome or even encourage a second opinion. In reality, there may be some doctors who resent it and feel it undermines their authority. If a doctor is reluctant or dismissive about your getting a second opinion, that may be all the more reason to get one.
How do you find a second doctor?
If you live in a small town or have a rare condition, you may not actually have a lot of choice. But assuming you have at least some choice, you could ask friends, family and other people in your social networks, search for relevant specialists online or check out patient support group forums.
Ask your GP if they referred you to the first specialist, you could ask for a referral to a second.
You could also ask your health insurance fund some, including HCF, HIF and CBHS, offer a second opinion service called Best Doctors, an international coalition of thousands of medical specialists. The doctors are sent medical files and treatment plans to review, though don’t actually meet the patient. Some life insurance companies offer it too.
Should you disclose it’s a second opinion?
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What If The Second Opinion Disagrees With The First
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.