After receiving a troubling medical diagnosis, there is sometimes confusion regarding the accuracy of the diagnosis as well as the recommended treatment options. Many people often want a second opinion to help decide what to do. Obtaining a second opinion could be costly, but in Florida you may not have to choose. Florida recognized the need for second opinions after obtaining certain medical determinations and acknowledged that the benefits of a second opinion far outweigh the costs. Soon after, Florida became one of the few states to enact legislation that outlines the instances in which an enrollee is entitled to seek a second medical opinion.
When are you entitled to a second opinion?
In Florida, a health organization is obligated to allow a second opinion when an enrollee disputes a healthcare organization’s or a physician’s opinion relating to a surgical procedure. If you have been to a doctor and you do not agree with the doctor’s finding about the reasonableness or necessity of a surgical procedure, then you have the right to obtain a second opinion. Additionally, a health organization is also obligated to allow a second opinion when
you are subject to serious injury or illness. In these circumstances, a second opinion will be beneficial unless your condition is life-threatening and requires immediate action.
What are the costs associated with a second opinion?
The reality for many Americans is that there are very little savings accumulated at the end of each month. With rising healthcare costs, doctor’s visits are a cause for concern. If you seek a second opinion from a physician that is “in-network” with your insurance plan, your fees may be less. You have the ability to choose the physician that will provide the second opinion. If a physician is “in-network”, the organization may not charge any more than the fees established by contract for a referral contract physician. If the physician is not “in-network”, your health insurance is required to pay the amount of all charges that are usual, reasonable, and customary in the community. However, you may be required to pay up to 40 percent of the fees for physicians that are not “in-network”.
What are the limitations surrounding special opinions?
Generally, you are limited to obtaining three second opinions per year. After that, an insurance company can deny subsequent costs if they determine that you over utilized the second opinion privileges. Additionally, you should be aware that there are exceptions for those with chronic and disabling conditions and should ask your insurance company directly about this.
Conclusion
Florida’s statute requiring health insurance providers to cover all or some of the costs associated with a second opinion is a benefit that many Americans don’t have. However, the process is not seamless. You should contact your insurance company to ask them specifically about their policy regarding second opinions.
At Bounds Law Group, we limit our practice to Medical Malpractice. If you believe you or your family may have been a victim of Medical Malpractice, we would be happy to speak with you. Call us at 877.644.5122.