A second opinion is another doctor's view of your health problem and how it should be treated, and it is one way to check a diagnosis or a recommended treatment you are unsure of. When the diagnosis is a serious illness or the recommendation is surgery, a second opinion is common, and your insurance plan may even require one. Doctors are used to the request, and most will not be insulted by it.
Getting names for a second opinion without going around your doctor
Start with the doctor whose recommendation you want checked: tell them you want a second opinion, and ask whether they can suggest other doctors who can review your case. Hearing the views of two different doctors can help you decide what is best for you. While you have the first doctor's attention, ask how soon treatment should start, so you know how much time there is to see someone else.
Other ways to find doctors include asking another doctor you trust for a list, and online resources that help you find a doctor.
When to seriously consider a second opinion about cancer
With a cancer diagnosis, a second opinion is your right as a patient, and you should seriously consider one if:
- you have been diagnosed with a rare type of cancer
- you received very different recommendations on how to treat it
- your doctor does not have a lot of experience treating your type of cancer
- you have several options for treatment and feel unsure what to do
- your test results are unclear about the type and location of the cancer
- you are not comfortable with your diagnosis or treatment plan
Doctors are usually happy to help patients with cancer arrange a second opinion, and your doctor may even recommend one when the best treatment approach is not clear. You can get a second opinion even if you have already had treatment, and the second doctor can make recommendations for how your treatment will go on or may change.
Cancer care often involves a group of doctors working together. Ask your doctor whether they have already discussed your case with other doctors, which often happens when surgery or radiation therapy is being considered. Friends or family who have been treated for cancer may also know a doctor to recommend.
What the second doctor needs from you before the appointment
The second doctor will meet with you, perform a physical exam and review your medical history and test results, so your records need to reach them before the visit or come with you to it. Ask the second doctor's office whether they want the records sent ahead or brought on the day, and in what form, then call that office before the appointment to check that anything you sent has arrived.
Before the visit, ask the first doctor to give you the treatment directions in writing, and take that page to the second doctor so they see the recommendation as it was given.
To the appointment, bring:
- copies of your medical records, if you have not already sent them, and x-rays and scans if you are asked for them, on film or CD or viewable through a patient portal
- a list of all the medicines you take now, including vitamins and supplements
- a list of your questions
- a family member or friend, if you would like one, for support and to help you understand the doctor's advice, and they can ask questions too
At the visit, go over the diagnosis and treatment your first doctor recommended with the second doctor. If the recommendation is an operation and one of your medicines is a weekly weight medicine, tell the anesthesia team about it before the operation as well (see Tell the anesthesia team about your weekly weight medicine).
For the list of questions you bring, start with these questions to ask a doctor: "Why do I need this treatment?", "Are there any alternatives?" and "What are the possible complications?" If the recommendation is an operation, add "How many times have you done this procedure?"
Who pays for the second visit
Before you book the second visit, call your insurer, at the number on your insurance card, and ask whether a second opinion is covered under your policy, whether there are restrictions on which doctors you can see, and whether you need a referral form from your primary doctor. With a Marketplace plan, if you cannot find your insurer's number, the Marketplace Call Center at 1-800-318-2596, TTY 1-855-889-4325, can help you find it.
With Medicare, Part B covers a second opinion in some cases, for surgery that is medically necessary and not an emergency. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for it. If the second doctor asks you to get additional tests as a result of the visit, Medicare covers them as it covers other medically necessary services. The second doctor may recommend services Medicare does not cover, so ask them about the reasons for a recommended test and what Medicare will actually cover. The amount you owe also depends on things such as other insurance you have, how much the doctor charges and the type of facility, so ask the second doctor's office what the visit and any tests will cost.
Most health plans give you the best deal on services when you see a doctor who has a contract with your plan. You may be able to see doctors who do not contract with it, but an in-network provider usually means lower out-of-pocket costs, and many insurance plans limit the providers you can choose from, or give you a financial incentive to select from a specific list. For a Marketplace plan, ways to check a named doctor include the provider directory on the plan's website, a call to your insurer and a call to that doctor's office, which can tell you whether it accepts your plan.
If your plan does not pay for the visit, you can ask your insurance company to review its decision in an internal appeal, and it has to tell you why it denied the claim. Only some kinds of denial can then go to an independent reviewer, including any denial that involves medical judgment where you or your doctor may disagree with the plan.
When the two doctors tell you different things
If the second opinion differs, you still have choices: you could go back to your first doctor and discuss it, and you may decide together to change your treatment based on this new information, or you can seek the opinion of a third doctor, which could help you decide which of the first two options is better for you. If the second opinion matches the first, you can feel more confident in your diagnosis and treatment plan. Even after a second or third opinion, you do not have to switch doctors, and you choose which doctor provides your treatment.
With Medicare, a third surgical opinion is covered if the first and second opinions are different, and your share of its cost is the same as for the second opinion.
To weigh the two plans, ask each doctor about the pros and cons of each plan: what side effects might occur, how long the treatment would continue, and how likely it is that the treatment will work for you. Tell each doctor about anything that would make a plan hard to live with, such as a side effect that would get in the way of an activity that means a lot to you, or a cost your insurance does not cover, because doctors need to know these practical matters to work out a plan that meets your needs.
If the plan you want checked is your NicoCares treatment plan, use Spruce, the app NicoCares invited you to by email, to let the care team know you are getting a second opinion. An independent physician licensed in your state reviews your eligibility answers, medical intake, ID and check-ins to decide what is clinically appropriate. If you want the second doctor to see that information, ask NicoCares for a copy of the personal information it holds about you by emailing [email protected] from the address on your account, or by naming that address in your message. NicoCares confirms your identity before acting and replies within 45 days, or tells you if it needs longer and why, so ask early if treatment cannot wait.
