Advertisement

Will health insurance cover the cost of getting a second opinion?

Dr. Michael Roizen, MD
Internal Medicine

Most insurance plans cover second opinions because they care about you -- and because it makes good financial sense. They’d rather not pay $50,000 for that heart operation when there’s a chance that you need only a $3,500 preventive-medicine plus a statin drug regimen and lifestyle change.  For this reason, many insurers require you to get a second opinion before they’ll pay for certain major procedures.

Not all insurance plans are so forward thinking, sadly. If you have an HMO or managed care plan, it may not cover a second opinion. Before you whip out your checkbook, though, read your entire policy carefully and check the laws in your state. Some states, including California and New York, have passed laws that guarantee members of HMOs the right to get a second opinion.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
Most health insurance plans cover second opinions, because it makes good financial sense. They'd rather not pay $50,000 for a heart operation when there's a chance that you only need a $3500 preventive medicine program.

For this reason, many health insurance plans require you to get a second opinion before they'll pay for certain major procedures, so you won't have the option of forgoing it (and this is a fantastic thing for patients who'd be too sheepish to get a second opinion on their own).

Not all insurance plans are so forward thinking, sadly. If you have an HMO or managed care plan, for example, it may not cover a second opinion. If you can't persuade the insurer to open their wallet, it may be well worthwhile to pay for the second opinion out of your own pocket. Sure, this won't be cheap, but it could be the best money you'll ever spend in your life.

Before you whip out your checkbook, though, read your entire policy carefully and check the laws in your state. Some states, including California and New York, have passed laws that guarantee members of HMOs the right to get a second opinion.
YOU: The Smart Patient: An Insider's Handbook for Getting the Best Treatment

More About this Book

YOU: The Smart Patient: An Insider's Handbook for Getting the Best Treatment

Everyone needs to become a smart patient. In fact, in the worst cases, your life may even depend on it. Number one bestselling authors and doctors Michael Roizen and Mehmet Oz have written this...

Continue Learning about Medicare

A Last-Minute Guide to Shopping for Medicare
A Last-Minute Guide to Shopping for Medicare
Medicare’s annual open enrollment period is about to come to a close. December 7 is your final chance to change from one Medicare Advantage or prescri...
Read More
How do I file a Medicare claim?
Dr. Michael Roizen, MDDr. Michael Roizen, MD
If you are enrolled in Original Medicare (Medicare Advantage does not have to file claims) you can...
More Answers
Will my Medicare Part D premiums increase if I earn too much money?
AARPAARP
The income levels for higher premiums start at $85,000 for a single person or $170,000 for married c...
More Answers
What Type of Policy Changes Is AARP Advocating?
What Type of Policy Changes Is AARP Advocating?

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.