Second Opinions. The Member may access a second opinion from a Network Provider regarding a medical diagnosis or treatment plan. The Member may request Preauthorization or may visit a KFHPWA-designated Specialist for a second opinion. When requested or indicated, second opinions are provided by Network Providers and are covered with Preauthorization, or when obtained from a KFHPWA-designated Specialist. Coverage is determined by the Member's EOC; therefore, coverage for the second opinion does not imply that the services or treatments recommended will be covered. Preauthorization for a second opinion does not imply that KFHPWA will authorize the Member to return to the physician providing the second opinion for any additional treatment. Services, drugs and devices prescribed or recommended as a result of the consultation are not covered unless included as covered under the EOC.
Second Opinions. The Contractor shall provide for a second opinion from a qualified Network Provider, or arrange for the Enrollee to obtain one from a Non-Network Provider, at no cost to the Enrollee.
Second Opinions. The Contractor shall provide for a second opinion from a qualified health care professional within the network, or arrange for the Enrollee to obtain one outside the network at no cost to the Enrollee.
Second Opinions. The CONTRACTOR shall:
4.7.1. Provide for a second opinion in any situation where there is a question concerning a diagnosis or the options for surgery or other treatment of a health condition when requested by a Member, parent and/or legally appointed Representative.
4.7.2. Require contracted Providers to provide the second opinion or the CONTRACTOR shall arrange for a Member to obtain one from an out-of-network Provider when a qualified Provider is not available in network.
4.7.3. The second opinion shall be provided at no cost to the Member.
Second Opinions. 4.11.7.1 The Contractor shall provide for a second opinion in any situation when there is a question concerning a diagnosis or the options for surgery or other treatment of a health Condition when requested by any Member of the Health Care team, a Member, parent(s) and/or guardian (s), or a social worker exercising a custodial responsibility.
4.11.7.2 The second opinion must be provided by a qualified Health Care Professional within the network, or the Contractor shall arrange for the Member to obtain one outside the Provider network.
4.11.7.3 The second opinion shall be provided at no cost to the Member.
Second Opinions. The Plan provides Benefits for second opinions when provided by a Network Provider with no practice association with the original Provider.
Second Opinions. RWS reserves the right to a second opinion after the diagno- sis of a covered issue by an approved RWS contractor, at the cost of RWS and at no further cost to the contract holder. In the case of a contract holder opting to utilize their own contractor, RWS reserves the right to a second opinion after diagnosis and estimates, at the cost of RWS less the deduct- ible that applies to that claim.
Second Opinions. The Contractor shall have policies and procedures for rendering second opinions by Providers within the network, or by non-participating Providers. Upon request, the Contractor must provide for a second opinion from a qualified health care professional within the network, or arrange for the Member to obtain one outside the network from an Out-of-network Provider, at no cost to the Member.
Second Opinions. The insured person is not covered for the costs of any second or subsequent medical opinions from a medical practitioner or specialist for the same medical condition other than stated in the insured person’s certificate of insurance, unless authorised by the insurer.
Second Opinions. The Contractor shall have a Second Opinion program that can be utilized at the enrollee's option for diagnosis and treatment of serious medical conditions, for elective surgical procedures, when a physician recommends a treatment other than what the Member believes is necessary, or if the Member believes they have a condition that the physician failed to diagnose. The program can also be utilized at the enrollee’s option for diagnosis and treatment of dental conditions that are treated within a dental specialty. In addition, the Member may receive the second opinion within the Contractor’s network or the Contractor may arrange for the Member to obtain a second opinion outside the network at no cost to the Member. The Second Opinion program shall be incorporated into the Contractor’s medical and dental procedures and submitted to DMAHS for review and approval.
