Second Medical Opinion Policy. If you have a question about your diagnosis or be- lieve that additional information concerning your condition would be helpful in determining the most appropriate plan of treatment, you may make an appointment with another Physician for a sec- ond medical opinion. Your attending Physician may also offer to refer you to another Physician for a second opinion. Remember that the second opinion visit is subject to all benefit limitations and exclusions.
Second Medical Opinion Policy. Members who have questions about their diagnoses, or believe that additional information concerning their condition would be helpful in determining the most appropriate plan of treatment, may make an appointment with another Physician for a second medical opinion. The Member’s attending Physician may also offer a referral to another Physician for a second opinion. The second opinion visit is subject to the applicable Copayment, Coinsurance, Calendar Year Deductible and all plan contract Benefit limitations and exclusions.
Second Medical Opinion Policy. If you have a question about your diagnosis, or believe that additional information concerning your condition would be helpful in determining the most appropriate plan of treatment, you may make an appointment with another physician for a second medical opinion. Your attending physician may also offer to refer you to another physician for a second opinion. Remember that the second opinion visit is subject to all Plan contract benefit limitations and exclusions. Additionally, please see the section entitled "Your Blue Shield of Califor- nia Shield Spectrum PPO Plan and How to Use It" regarding advantages from selecting a Preferred Physician for these services. Utilization Review State law requires that health plans disclose to Members and health plan providers the process used to authorize or deny health care services under the plan. Blue Shield of California has completed documentation of this as required under Sec- tion 1363.5 of the California Health and Safety Code. The document describing Blue Shield’s Utilization Management Program is available online at xxx.xxxxxxxxxxxx.xxx or Member’s may call the Customer Service Department at the telephone number provided on the back page of this Evidence of Coverage to request a copy. Health Education and Health Promotion Health education and health promotion services provided by Blue Shield of California include the Blue Shield of Califor- nia Member Newsletter. Additionally, Blue Shield of Cali- fornia's Internet site is located at xxxx://xxx.xxxxxxxxxxxx.xxx. Subscribers using a personal computer and modem with World Wide Web access may view and download healthcare information. Retail-Based Health Clinics Retail-based health clinics are Outpatient facilities, usually attached or adjacent to retail stores, pharmacies, etc…, which provide limited, basic medical treatment for minor health issues. They are staffed by nurse practitioners under the di- rection of a Physician and offer services on a walk-in basis. Covered Services received from retail-based health clinics will be paid on the same basis and at the same Benefit levels as other covered Services shown in the Summary of Benefits. Retail-based health clinics may be found in the Preferred Provider Directory or the Online Physician Directory located at xxxx://xxx.xxxxxxxxxxxx.xxx. See the Blue Shield of Cali- fornia Preferred Providers section for information on the ad- vantages of choosing a Preferred Provider. NurseHelp 24/7 If you are unsure about what ca...
Second Medical Opinion Policy. Members who have questions about their diagnoses, or believe that additional information concerning their condition would be helpful in determining the most appropriate plan of treatment, may make an appointment with another Physician for a second medical opinion. The Member’s attending Physician may also offer a referral to another Physician for a second opinion. The second opinion visit is subject to the applicable Copayment, Coinsurance, Calendar Year Deductible and all plan contract Benefit limitations and exclusions. and have contracted with the MHSA to provide Mental Health Services and Substance Abuse Services to Blue Shield Members. A Blue Shield Participating Provider may not be an MHSA Participating Provider. It is the Member’s responsibility to ensure that the provider selected for Mental Health and Substance Abuse Services Services for Emergency Care The Benefits of this plan will be provided for Emergency Services received anywhere in the world for the emergency care of an illness or injury. For Emergency Services from either a Participating Provider or a Non-Participating Provider, the Member is only responsible for the applicable Deductible, Copayment or Coinsurance as shown in the Summary of Benefits, and is not responsible for any Allowable Amount Blue Shield is obligated to pay. Members who reasonably believe that they have an emergency medical condition which requires an emergency response are encouraged to use the “911” emergency response system (where available) or seek immediate care from the nearest Hospital. For the lowest out-of-pocket expenses, covered non-Emergency Services or emergency room follow-up services (e.g., suture removal, wound check, etc.) should be received in a Participating Physician’s office. NurseHelp 24/7 SM The NurseHelp 24/7SM program offers Members access to registered nurses 24 hours a day, seven days a week. Registered nurses can provide assistance in answering many health-related questions, including concerns about:
Second Medical Opinion Policy. Members who have questions about their diagnoses, or believe that additional information concerning their condition would be helpful in determining the most appropriate plan of treatment, may request a referral from their Personal Physician to another Physician for a second medical opinion. The Member’s attending Physician may also offer a referral to another Physician for a second opinion. If the second opinion involves care provided by the Member’s Personal Physician, the second opinion will be provided by a Physician within the same Medical Group/IPA. If the second opinion involves care received from a Specialist, the second opinion may be provided by any Blue Shield Specialist of the same or equivalent specialty. All second opinion consultations must be authorized by the Medical Group/IPA.
Second Medical Opinion Policy. Members who have questions about their diagnoses, or believe that additional information concerning their condition would be helpful in determining the most appropriate plan of treatment, may make an appointment with another Physician for a second medical opinion. The Member’s attending Physician may also offer a referral to another Physician for a second opinion. The second opinion visit is subject to the applicable Copayment, Coinsurance, Calendar Year Deductible and all plan contract Benefit limitations and exclusions. NurseHelp 24/7 SM The NurseHelp 24/7SM program offers Members access to registered nurses 24 hours a day, seven days a week. Registered nurses can provide assistance in answering many health-related questions, including concerns about:
Second Medical Opinion Policy. Members who have questions about their diag- noses, or believe that additional information con- cerning their condition would be helpful in deter- mining the most appropriate plan of treatment, may make an appointment with another Physician for a second medical opinion. The Member’s at- tending Physician may also offer a referral to an- other Physician for a second opinion. The second opinion visit is subject to the applica- ble Copayment, Coinsurance, Calendar Year De- ductible and all Plan Contract Benefit limitations and exclusions. State law requires that health plans disclose to Members, upon request, the timelines for respond- ing to a request for a second medical opinion. To request a copy of these timelines, you may call the Customer Service Department at the number pro- vided on the back page of this EOC.
Second Medical Opinion Policy. If you have a question about your diagnosis or believe that additional information concerning your condition would be helpful in determining the most appropriate plan of treatment, you may make an appointment with another Physician for a charges incurred together with the documentary evidence of the action taken relative to such charges by the Department of Health and Human Services under Medicare. All requests for payments and claim forms are to be sent to Blue Shield of California, P.O. Box 272540, Chico, California, 95927-2540. No sums payable hereunder may be assigned without the written consent of Blue Shield. This prohibition shall not apply to ambulance Services or certain Medicare providers as required by section 4081 of the Omnibus Budget Reconciliation Act of 1987 (P.L. 100-203) for which Blue Shield shall provide payment directly to the provider. PLEASE READ THE FOLLOWING INFORMATION SO YOU WILL KNOW FROM WHOM OR WHAT GROUP OF PROVIDERS HEALTH CARE MAY BE OBTAINED. An individual Subscriber may select any Hospital or Physician to provide covered Services hereunder, including such providers outside of California that meet similar requirements as shown in the definitions of these terms. second medical opinion. Your attending Physician xxx also offer to refer you to another Physician for a second opinion. Remember that the second opinion visit is subject to all benefit limitations and exclusions.
