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In the United
States, every patient is entitled to as complete
an explanation as possible about any diagnosis
or recommended therapy. Only with this
information can a patient make an informed
decision (called "informed consent") about
whether to accept, refuse or delay a proposed
treatment.
It's always important to have a good
understanding of a diagnosis and the recommended
treatment. It is critical when you or the person
you care for is facing a potentially
life-threatening disease or major surgery. In
fact, the greater the severity of a diagnosis,
or the more radical the recommended treatment,
the more you should consider getting another
opinion from a second physician.
Your primary doctor should support your decision
to ask for a second opinion.
What
Situations Might Call For A Second Opinion?
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Surgery has been recommended.
As you know, older people often react badly to
anesthesia. You might want to explore all
non-surgical options for treatment of a
non-emergency problem.
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You have been
diagnosed with a life-changing or life-limiting
disease. One very common example might be
Parkinson's Disease (among many, many others).
Parkinson's-like symptoms can be caused by
several things. Treatments differ, and treatment
for one disease can be counter-productive for
another. In this case you would want the
diagnosis to be confirmed by an expert.
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Your doctor is
suggesting that you choose between two or more
non-surgical treatment options. Patients are
rarely in a position to make an informed choice
between treatment options without a second
opinion.
How Do
I Find A Doctor To Give A Second Opinion?
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Ask your primary doctor for
the name of a physician who specializes in the
problem you want to discuss. Most doctors will
support your desire for a second opinion, so
don't hesitate to ask. If your doctor is
offended, is this the physician you want to have
overseeing your care?
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If you don't want to
ask the doctor who recommends the surgery, ask
another doctor you trust for the name of a
doctor to see for a second opinion. Make sure
the second doctor accepts Medicare.
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Ask your local medical
society for the names of doctors who specialize
in treating treat your illness or injury.
When you have selected the doctor you want to
see for a second opinion, ask the doctor who
made the first diagnosis or treatment
recommendation to send your medical records to
the doctor who will be giving the second
opinion.
It will be your responsibility to make sure that
all medical records, including your full medical
history, tests, and x-rays related to the first
doctor's opinion are sent to the second opinion
physician. Make sure they arrive some time
before your appointment, so the second physician
has time to review the records. This can
eliminate delays, duplication of tests and
additional costs.
Call the office of your second doctor before you
go to make sure that all your records have
arrived.
Questions To Ask Of The Second Doctor
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Is the doctor a Board
certified specialist in the medical area you are
inquiring about?
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How frequently does
this physician perform the surgery or treatment
you are inquiring about?
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What is this doctor's
diagnosis?
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What are the treatment
options and alternatives, and what does this
specialist recommend?
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What are the risks and
benefits of the recommended treatment?
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How often has this
doctor performed the surgery or treatment he or
she recommends?
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Will my insurance or
managed care plan cover the recommended surgery
or therapy?
How Do
I Pay For A Second Opinion?
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Medicare Part
B helps pay for a second opinion just as it
helps pay for other doctors' services that are
medically necessary.
If you have Medicare Part B and are in the
Original Medicare Plan:
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Medicare will pay 80%
of the approved amount for a second opinion.
Your co-payment is usually 20% of the
Medicare-approved amount after you have paid
your annual Part B deductible. If you have a
Medi-Gap or secondary Medicare policy, it might
cover your co-payment and deductible amounts,
depending on which plan you have.
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If the second opinion
doesn't agree with the first, Medicare will pay
80% of the approved amount for a third opinion.
Your Medi-Gap policy might cover your
out-of-pocket charges.
If you are in a Medicare Managed Care Plan, you
have the right to get a second opinion. Some
plans will only pay for a second opinion if you
first get a referral from your primary care
doctor. You must get the second opinion from the
doctor named in the referral. If you want to get
a second opinion from a doctor who doesn't
belong to your plan, talk to your plan first.
Some plans will let you do this, but most won't.
If you are in a Medicare Preferred Provider
Organization Plan or a Private Fee-For-Service
Plan, Medicare covers a second opinion. If the
first two opinions are different from each
other, these plans will pay for a third opinion.
If you have Medicaid, it might also pay for
second surgical opinions. To find out, call your
state medical assistance office.
As the patient or caregiver for someone facing a
serious medical issue, you want to make informed
decisions about accepting or refusing
recommended treatments. Requesting a second, or
even a third, opinion can add to your confidence
that you are making the right choice about your
choice of your treatment and your physician.
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