Second Medical Opinions. Members are entitled to a second medical opinion when disputing the appropriateness or necessity of a surgical procedure, or when subject to a serious injury or illness.
Second Medical Opinions. AvMed may limit second medical opinions in connection with a particular diagnosis or treatment to three per Calendar Year, if AvMed deems additional opinions to be an unreasonable over-utilization by the Member.
Second Medical Opinions. The County must have written policies for procedures guaranteeing each member’s right to receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand for providing members the opportunity to have a second opinion from a qualified network provider subject to referral procedures approved by the Department. If an appropriately qualified provider is not available within the network, the County must authorize and reimburse for a second opinion outside the network at no charge to the member, excluding allowable copayments.
Second Medical Opinions. An enrollee or participating provider, who is treating an enrollee, may request a second medical opinion by an appropriately qualified health care professional. Reasons for a second opinion to be provided or authorized shall include, but are not limited to, the following: • Reasonableness or necessity of recommended treatment is questioned. • Diagnosis or treatment plan is questioned. • Clinical indications are not clear or are complex and confusing. • Treatment plan in progress is not improving the condition of the enrollee within an appropriate period of time given the diagnosis and plan of care. Xxxxxx'x decision to xxxxx or deny the request for a second medical opinion will be delivered to the individual who requested the second medical opinion. If the enrollee faces an imminent and serious threat to his or her mental health, the second opinion shall be rendered within (72) hours after the receipt of the request. If the request for a second opinion is approved, the enrollee will be responsible for all applicable copayments. If the request for a second opinion is denied, the enrollee will be notified in writing of the reasons for the denial and shall be informed of the right to file a grievance with the Plan. The request for a second medical opinion can be made by calling Xxxxxx at 1-800-321- 2843, or by writing to: Xxxxxx Professional Counseling Centers, Care Management Department, PO Box 8011, Canoga Park, CA 91309.
Second Medical Opinions. The County PIHP must have written policies for procedures guaranteeing each member’s right to receive information on available treatment options and alternatives, presented in a manner appropriate to the member’s condition and ability to understand for providing members the opportunity to have a second opinion from a qualified network provider subject to referral procedures approved by the Department. If an appropriately qualified provider is not available within the network, the County PIHP must authorize and reimburse for a second opinion outside the network at no charge to the member, excluding allowable copayments.
