Common use of Mandatory Second Surgical Opinion Clause in Contracts

Mandatory Second Surgical Opinion. For specified non-emergency surgeries, a second surgical opinion shall be required. The second opinion shall be covered at one hundred percent (100%) of the usual, customary and reasonable (UCR) charges. If the first two opinions conflict, a third opinion shall also be covered at one hundred percent (100%) of UCR charges. If a second opinion is not obtained for the specified surgeries, a ten percent (10%) co-insurance shall be applied, in addition to the deductible and co-insurance provisions. This ten percent (10%) co-insurance does not apply to the out-of-pocket maximum. Based on medical information obtained prior to the surgery, the City’s medical utilization review administrator may waive the mandatory second surgical opinion required in specific cases.

Mandatory Second Surgical Opinion. For specified non-emergency surgeries, a second surgical opinion shall be required. The second opinion shall be covered at one hundred percent (100%) of the usual, customary and reasonable (UCR) charges. If the first two opinions conflict, a third opinion shall also be covered at one hundred percent (100%) of UCR charges. If a second opinion is not obtained for the specified surgeries, a ten percent (10%) co-co- insurance shall be applied, in addition to the deductible and co-insurance provisions. This ten percent (10%) co-insurance does not apply to the out-of-pocket maximum. Based on medical information obtained prior to the surgery, the City’s medical utilization review administrator may waive the mandatory second surgical opinion required in specific cases.

Mandatory Second Surgical Opinion. For specified all inpatient and outpatient non-emergency surgeries, a second surgical opinion shall may be requiredrequired as directed by the utilization review administrator. The This second opinion shall be covered at one hundred percent (100%) of the usual, customary and reasonable (UCR) charges. If the first two opinions conflict, a third opinion shall also be covered at one hundred percent (100%) of UCR reasonable charges. If a second opinion is not obtained for the specified surgeries, a ten percent (10%) co-insurance penalty of total charges shall be applied, in addition to the deductible deductible, coinsurance and co-insurance provisions. This ten percent (10%) co-insurance does not apply to the out-of-out of pocket maximum. Based on medical information obtained prior to the surgery, the City’s 's medical utilization review administrator may waive the mandatory second surgical opinion required requirement in specific cases.