SECOND SURGICAL OPINION. The medical opinion of a physician other than the current attending physician (approved and required by USA Medical Services).
SECOND SURGICAL OPINION. An individual covered under the State Health 39 Plan will be entitled to a second surgical opinion. If that opinion conflicts 40 with the first opinion the individual will be entitled to a voluntary third 41 surgical opinion. Second and third surgical opinions shall be subject to a 1 $10 in-network office call fee or covered at 90% after the deductible if 2 obtained out-of-network. 3 Effective 10-1-08, second and third surgical opinions shall be subject to a 4 $15 in-network office call fee or covered at 90% after the deductible if 5 obtained out-of-network.
SECOND SURGICAL OPINION. The medical opinion of a physician other than the current attending physi- cian (approved and required by USA Medical Services).
SECOND SURGICAL OPINION. The INSURER will establish a program to allow beneficiaries to obtain a second surgical opinion for elective surgical procedures on a voluntary basis, as described in the INSURER's Proposal.
SECOND SURGICAL OPINION. A benefit will be provided to pay reasonable charges incurred by an employee or dependent for consultations (including the reasonable charges for laboratory and XÄray examinations and other diagnostic procedures in connection therewith) with one or more qualiÄ fied specialist surgeons for additional opinions as to the medical necessity for the performance of a recommended surgical procedure for which benefits are payable under the surgical expense benefits provisions of the Plan, provided the consultant surgeon examines the patient and furnishes the insurer either copy of his written report to the patient or a written report setting forth his opinion.
SECOND SURGICAL OPINION. Effective 10/1/89, the mandatory Second Surgical Opinion program shall be modified as set forth herein and referred to as focused second surgical opinion. The focused second surgical opinion shall be part of the pre-certification for inpatient hospital admission. A mandatory second surgical opinion shall be required for the following types of elective surgery. For purposes of this Article, elective surgery shall be defined as a procedure which may safely be delayed without compromising the employee's health. This list of surgeries may be reviewed by the UAW-OSE Labor Management Health Care Committee and, upon mutual agreement, modified. - Knee Surgery - Hysterectomy - Tonsillectomy/Adenoidectomy - Cholecystectomy - Partial or Complete Mastectomy - Excision of Cataracts - Rhinoplasty/Submucous Resection - Dilation and Curretage - Varicose Vein Stripping and Ligation - Prostatectomy - Laminectomy - Heart Surgery - Bladder Surgery - Herniorrhaphy - Tubal and Ovarian Surgery - Carpal Tunnel In the event that any of these types of surgery is recommended to the employee or enrolled family member, a second surgical opinion is to be sought. The attending physician shall initiate the second opinion referral at the time the physician contacts the third party administrator for pre- certification for admission. Based upon the medical data provided and the procedure to be done, the physician will be advised if a second opinion is required. If necessary, the employee or dependent will then be contacted to advise him/her of the second opinion requirement and to select a consultant from the panel. The appointment with the chosen consultant will be scheduled for the employee/dependent. The second opinion requirement will be waived when an appointment with an appropriate consultant cannot be scheduled within three (3) weeks, if the surgery is to be performed out-of-state, if the surgery is to be performed on a person enrolled in Medicare, or as otherwise provided in this Section. The physician providing the second opinion shall furnish to the employee and the third party administrator a copy of the diagnosis, prognosis, and recommended treatment. In the event that no board certified specialist is available within 100 miles of the employee's residence, the requirement for a second opinion will be waived by the third party administrator. If an employee has to drive 50 miles or less one way from the employee's residence to get the second opinion, there shall be no mileage reim...
SECOND SURGICAL OPINION. We shall reimburse the Reasonable and Customary Charges for consultation with a Specialist to obtain a second opinion prior to Surgery in respect of an Illness or Injury requiring Surgery up to the maximum amount as set forth in the Schedule of Benefits. Payment will not be made where You do not result in Hospital confinement for the treatment of the medical condition diagnosed.
SECOND SURGICAL OPINION. Whenever an employee has made a determination to undergo elective or non-emergency surgery, the cost of which would be reimbursed by the carrier, said employee may be required by the carrier to first obtain a second opinion from a qualified physician prior to undergoing the surgery. (The second opinion will be advisory only and would be paid for by the carrier). These procedures outlined in this Section shall not go into effect until the City notifies the Union that the carrier is ready to implement said procedures. The procedures listed in J(1) through J(4) may be implemented by the carrier on an individual basis (e.g. J(3) only) or a complete basis (J(1) through J(4)).
SECOND SURGICAL OPINION. Whenever an employee has made a determination to undergo elective or non-emergency surgery, the cost of which would be reimbursed by the carrier, said employee may be required by the carrier to first obtain a second opinion from a qualified physician prior to undergoing the surgery. (The second opinion will be advisory only and would be paid for by the carrier.) These procedure(s) outlined in this Section shall not go into effect until the City notifies the Union that the carrier is ready to implement said procedures. The procedures listed in 7(a) through 7(d) may be implemented by the carrier on an individual basis (e.g. 7(c) only) or a complete basis (7(a) through 7(d)).
SECOND SURGICAL OPINION. A cost management program included under the terms of some Certificates that authorizes or requires a Covered Person to obtain a second surgical opinion for some or all elective surgeries. Service or Supply. A service, procedure, treatment, supply, product, drug, technology, equipment, device, setting or accommodation.
