How Medicare Handles Second Medical Opinions

Does Medicare cover second medical opinions? The doctor I currently see thinks I need back surgery, but I would like to find out more about other treatment options before I proceed. What can you tell me?

Medicare does pay for second opinions if your current doctor has recommended surgery or some other major diagnostic or therapeutic procedure. Getting a second medical opinion from another doctor is a smart idea. A second opinion may offer you a fresh perspective and additional options for treating your back condition so you can make a more informed decision. Or, if the second doctor agrees with your current doctor’s opinion, it can give you some reassurance moving forward.

If you are enrolled in original Medicare, 80% of the costs for second medical opinions are covered under Part B (you or your Medicare supplemental policy are responsible for the other 20%), and you do not need to obtain an order or referral from your doctor to see another doctor for a second opinion. Medicare will even pay 80% of the costs for a third medical opinion, if the first two differ. Most Medicare Advantage plans cover second opinions too, but you may need to follow certain steps to obtain coverage. For example, some plans will only help pay for a second opinion if you receive a referral from your primary care doctor. Plans also may require you to see doctors in their networks only. If you have a Medicare Advantage plan, you’ll need to call to find your plan’s rules.

Finding Another Doctor

To find a doctor for a second opinion you can ask your current doctor a recommendation, ask another doctor you trust for a referral or you can find one on your own. Whatever route you choose, it is best to go with a doctor that is affiliated with a different practice or hospital than your original doctor. Hospitals and practices may have set procedures and practices when it comes to treatments and are likely to offer similar advice.

If you choose to search for a doctor on your own, check out the Physician Compare tool at Medicare.gov/physiciancompare. This will let you find doctors by name, medical specialty or by geographic location that accept original Medicare. You can also get this information by calling Medicare at 800-633-4227. If you are enrolled in a Medicare Advantage plan, call or visit your plan’s website for a list of candidates. Once you have selected a second doctor, you will need to ask your current doctor’s office to send your medical records to the second doctor. Alternatively, you may be able to pick them up and deliver them yourself. By providing the second doctor your medical records, you can avoid repeating the tests you have already had. Note that, if the second doctor wants additional tests performed, Medicare will help pay for these tests too.  For more information, see the Medicare publication “Getting a Second Opinion Before Surgery” at medicare.gov/pubs/pdf/02173-Getting-a-Second-Opinion-Before-Surgery.pdf.

Savvy Living is written by Jim Miller, a regular contributor to the NBC Today Show and author of “The Savvy Living” book. Any links in this article are offered as a service and there is no endorsement of any product. These articles are offered as a helpful and informative service to our friends and may not always reflect this organization’s official position on some topics. Jim invites you to send your senior questions to: Savvy Living, P.O. Box 5443, Norman, OK 73070. Published June 22, 2018, Republished with permission

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