No one wants to take chances with their health but that is what you might be doing if you make major medical decisions without seeing what is behind door number two. Do you know your rights when it comes to getting a second opinion?
Why You Might Need a Second Opinion
Doctors may have years of training but they are only human. That means they make mistakes. Diagnostic errors happen in the outpatient setting 5% of the time, affecting as many as 12 million people each year. In the hospital, diagnostic errors are even more common.Getting a second opinion could decrease the odds that a diagnosis is wrong or missed altogether.
A 2017 study at the Mayo Clinic found that people who seek a second opinion will get a different diagnosis the majority of the time. While 66% of people get a more fine-tuned diagnosis as many as 21% get a new diagnosis altogether.
A 2018 study that focused on breast cancer patients found that seeking a second opinion changed the diagnosis for 43% of the study participants.Second opinions that result in diagnostic changes may affect cancer prognoses as well as treatment plans.
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 the20% Medicare Part B coinsuranceyou would pay for any other outpatient medical care.
Specifically, Medicare will pay for aboard-certified physicianto 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.
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 bemedically necessaryaccording to their standards. Of note, Medicare does not covercosmetic surgeryor procedures it considers to be experimental for this reason.
Deciding What to Do
Surgery is not something to be taken lightly. There could be complications and of course, there will be downtime required for recovery. You need to be comfortable that you are making the best decision for you. The same goes for any other medical tests or treatments that are recommended to you.
For these reasons, you should not be anxious about approaching your doctor with a request for a second opinion. To makeeducated choices about your health, you may need more information or reassurance regarding your medical options. Discuss any concerns you have with your doctor and request he forward all records for review to the new consultant.
A Word from VeryWell
Not every condition will require a second opinion. That said, if you are faced with a diagnosis that has a poor prognosis or one that has more complicated or costly treatment options, you may want to consider getting another evaluation to make sure you have all the information you need to make a decision on how to proceed. Medicare will support you as you get checked out.
4 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gupta A, Snyder A, Kachalia A, Flanders S, Saint S, Chopra V.Malpractice claims related to diagnostic errors in the hospital.BMJ Qual Saf. 2018;27(1):53-60. doi:10.1136/bmjqs-2017-006774Van Such M, Lohr R, Beckman T, Naessens JM.Extent of diagnostic agreement among medical referrals.J Eval Clin Pract. 2017;23(4):870-874. doi.10.1111/jep.12747Garcia D, Spruill LS, Irshad A, Wood J, Kepecs D, Klauber-DeMore N.The value of a second opinion for breast cancer patients referred to a National Cancer Institute (NCI)-designated cancer center with a multidisciplinary breast tumor board.Ann Surg Oncol. 2018;25(10):2953–2957. doi:10.1245/s10434-018-6599-yMedicare.gov.Second surgical opinions.
4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Gupta A, Snyder A, Kachalia A, Flanders S, Saint S, Chopra V.Malpractice claims related to diagnostic errors in the hospital.BMJ Qual Saf. 2018;27(1):53-60. doi:10.1136/bmjqs-2017-006774Van Such M, Lohr R, Beckman T, Naessens JM.Extent of diagnostic agreement among medical referrals.J Eval Clin Pract. 2017;23(4):870-874. doi.10.1111/jep.12747Garcia D, Spruill LS, Irshad A, Wood J, Kepecs D, Klauber-DeMore N.The value of a second opinion for breast cancer patients referred to a National Cancer Institute (NCI)-designated cancer center with a multidisciplinary breast tumor board.Ann Surg Oncol. 2018;25(10):2953–2957. doi:10.1245/s10434-018-6599-yMedicare.gov.Second surgical opinions.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Gupta A, Snyder A, Kachalia A, Flanders S, Saint S, Chopra V.Malpractice claims related to diagnostic errors in the hospital.BMJ Qual Saf. 2018;27(1):53-60. doi:10.1136/bmjqs-2017-006774Van Such M, Lohr R, Beckman T, Naessens JM.Extent of diagnostic agreement among medical referrals.J Eval Clin Pract. 2017;23(4):870-874. doi.10.1111/jep.12747Garcia D, Spruill LS, Irshad A, Wood J, Kepecs D, Klauber-DeMore N.The value of a second opinion for breast cancer patients referred to a National Cancer Institute (NCI)-designated cancer center with a multidisciplinary breast tumor board.Ann Surg Oncol. 2018;25(10):2953–2957. doi:10.1245/s10434-018-6599-yMedicare.gov.Second surgical opinions.
Gupta A, Snyder A, Kachalia A, Flanders S, Saint S, Chopra V.Malpractice claims related to diagnostic errors in the hospital.BMJ Qual Saf. 2018;27(1):53-60. doi:10.1136/bmjqs-2017-006774
Van Such M, Lohr R, Beckman T, Naessens JM.Extent of diagnostic agreement among medical referrals.J Eval Clin Pract. 2017;23(4):870-874. doi.10.1111/jep.12747
Garcia D, Spruill LS, Irshad A, Wood J, Kepecs D, Klauber-DeMore N.The value of a second opinion for breast cancer patients referred to a National Cancer Institute (NCI)-designated cancer center with a multidisciplinary breast tumor board.Ann Surg Oncol. 2018;25(10):2953–2957. doi:10.1245/s10434-018-6599-y
Medicare.gov.Second surgical opinions.
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