SECOND OPINION POLICY Clause Samples
The Second Opinion Policy clause establishes the right of a party to seek an independent professional evaluation or assessment, typically in situations involving medical, technical, or expert determinations. In practice, this means that if one party disagrees with an initial diagnosis, recommendation, or assessment provided under the contract, they may request a second opinion from a qualified third party, often at their own expense or as specified in the agreement. This clause helps ensure fairness and accuracy in decision-making by providing a mechanism to resolve doubts or disputes over expert judgments.
SECOND OPINION POLICY. It is the policy of CDN that a second opinion obtained from a participating panel provider will be a covered benefit. The covered benefit will need an approval from the Plan. A second opinion is encouraged as a positive component of quality of care.
SECOND OPINION POLICY. A second opinion may be required at Our discretion prior to the scheduling of certain Health Services. We will advise You if a proposed Health Service is subject to the second opinion policy. If so, You must consult with a second Participating Provider prior to the scheduling of the service.
SECOND OPINION POLICY. Coverage of certain Health Services as Network Benefits may require that Covered Persons consult a second Network Physician prior to the scheduling of the Health Service. The Company will notify them that a particular Health Service is subject to a second opinion Policy and will inform them of the required procedure for obtaining a second opinion.
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP, and the IDT. If you desire a second opinion, you should notify your PCP or nurse practitioner. A tuberculosis (TB) skin test(s) or chest X-ray is required upon enrollment. FHCN PACE will provide treatment if the TB test is positive. You may be fully and personally responsible to pay for unauthorized or out-of-PACE-network services, except for Emergency Services and Urgent Care (see “Reimbursement Provisions” in CHAPTER 5).
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your Primary Care Physician and the Interdisciplinary Team. If you desire a second opinion you should notify your Primary Care Physician or Nurse Practitioner. {PACE Program} will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling {insert phone # here} or contacting {insert name and address of appropriate entity here}. You may receive a standing referral to a medical specialist if you have HIV or AIDS or if your Primary Care Physician determines that you need the continuing care of a specialist. Your Primary Care Physician is responsible for approving a standing referral and will do so in accordance with {PACE Program’s} standing referral procedures. Additional information regarding standing referrals, including a list of specialists with expertise in caring for people with HIV or AIDS is available upon request by contacting your Primary Care Physician or {list additional contact person or place here} at {insert telephone # here}. Any claim that you may have against {PACE Program} or with respect to services provided by {PACE Program} must be brought by you within two years from the date you receive the service for which the claim is brought. In the case of personal injuries, the claim must be brought within one year from the date on which those injuries were sustained. A tuberculosis skin test(s) or chest X-ray is required prior to enrollment. If you do not meet a certain condition of {PACE Program} to receive a particular service, we reserve the right to waive such a condition if we, in our judgment, determine that you could medically benefit from receiving that service. However, if we do waive a condition for you in one instance, this does not mean that we are obligated to waive that condition or any other condition for you on any other occasion. You will be responsible to pay for unauthorized services, except for Emergency Services and Urgently Needed Care (see “Reimbursement Provisions” in CHAPTER FIVE). Payment for services provided under this Contract will be made by {PACE Program} to the provider. You cannot be required to pay anything that is owed by {PACE Provider} to the selected providers.
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP and the IDT. If you desire a second opinion you should notify your PCP or nurse practitioner. {PACE Organization} will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling {insert telephone number here} or contacting {insert name and address of appropriate entity here}. A tuberculosis (TB) skin test(s) or chest X-ray is required upon enrollment. {PACE Organization} will provide treatment if the TB test is positive. You will be responsible to pay for unauthorized services, except for Emergency Services and Urgent Care (see “Reimbursement Provisions” in CHAPTER 5). Payment for Services under this Enrollment Agreement Payment for services provided under this Enrollment Agreement will be made by {PACE Organization} to the provider. You cannot be required to pay anything that is owed by {PACE Organization} to the selected providers.
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP and the IDT. If you desire a second opinion, you should notify your PCP or nurse practitioner. CalOptima PACE will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling ▇-▇▇▇-▇▇▇-▇▇▇▇ or contacting: CalOptima PACE ▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇▇. Garden Grove, CA 92843 A tuberculosis (TB) skin test(s) or chest X-ray is required upon enrollment. CalOptima PACE will provide treatment if the TB test is positive. You will be responsible to pay for unauthorized services, except for emergency services and urgent care. (See “Reimbursement Provisions” in Chapter 5.)
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP and the IDT. If you desire a second opinion you should notify your PCP or nurse practitioner. GMWP will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling the GMWP Medical Director at at (▇▇▇) ▇▇▇-▇▇▇▇ at any time. For the hearing-impaired (TTY/TDD), please call (▇▇▇) ▇▇▇-▇▇▇▇. A tuberculosis (TB) skin test(s) or chest X-ray is required upon enrollment and annually as appropriate. GMWP will provide treatment if the TB test is positive. You will be responsible to pay for unauthorized services, except for Emergency Services and Urgent Care (see “Reimbursement Provisions” in CHAPTER 5). Payment for services provided under this Enrollment Agreement will be made by GMWP to the provider. You cannot be required to pay anything that is owed by GMWP to the selected providers.
SECOND OPINION POLICY. You may request a second medical opinion, as may others on your behalf, including your family, your PCP and the IDT. If you desire a second opinion you should notify your PCP or nurse practitioner. {PACE Organization} will issue a decision on second opinions within 72 hours. The timeline is available upon request by calling {insert telephone number here} or contacting {insert name and address of appropriate entity here}. You may receive a standing referral to a medical specialist if you have HIV or AIDS or if your PCP determines that you need the continuing care of a specialist. Your PCP is responsible for approving a standing referral and will do so in accordance with {PACE Program’s} standing referral procedures. Additional information regarding standing referrals, including a list of specialists with expertise in caring for people with HIV or AIDS is available upon request by contacting your PCP or {list additional contact person or place here} at {insert telephone number here}. Any claim that you may have against {PACE Organization} or with respect to services provided by {PACE Organization} must be brought by you within two years from the date you receive the service for which the claim is brought. In the case of personal injuries, the claim must be brought within one year from the date on which those injuries were sustained. A tuberculosis skin test(s) or chest X-ray is required prior to enrollment. If you do not meet a certain condition of {PACE Organization} to receive a particular service, we reserve the right to waive such a condition if we, in our judgment, determine that you could medically benefit from receiving that service. However, if we do waive a condition for you in one instance, this does not mean that we are obligated to waive that condition or any other condition for you on any other occasion.