Common use of Second Surgical Opinion Expenses Clause in Contracts

Second Surgical Opinion Expenses. 1. This plan pays a benefit for charges of a physician for a second surgical opinion on the need or advisability of performing a surgical or oral procedure for which the charges are a covered medical expense; which is recommended by the first physician who proposed to perform the surgery; and which is non-emergency. Non-emergency means the procedure can be postponed without undue risk to the patient. 2. A benefit is also payable for charges made for a third surgical opinion if the second surgical opinion does not confirm the recommendation of the first physician who proposed to perform the surgery. 3. A surgical opinion is an exam of the individual; x-ray and lab work; and a written report by the physician who is rendering the opinion. 4. The surgical opinion must both be performed by a physician who is certified by the American Board of Surgery or other specialty board; and take place before the date the surgery is scheduled to be performed. 5. Surgical opinion benefits are not payable for an opinion if the physician rendering the surgical opinion is associated or in practice with the first physician who recommended and proposed to perform the surgery. 6. If, in connection with one of the following surgical procedures when it is non-emergency in nature, a surgical opinion which would be covered under the plan is not obtained before surgery; or the only surgical opinion obtained is rendered by a physician associated or in practice with the first physician who recommended and proposed to perform the surgery; then the benefit payable for the charges incurred for the performance of the surgical procedure under any other part of this plan will be at the rate of fifty percent (50%) after the deductible: Hysterectomy Prostatectomy Knee Surgery Cholecystectomy Tonsillectomy Cataract Removal Adenoidectomy Herniorrhaphy Hemorrhoidectomy Hip Surgery Submucous Resection Laminectomy

Second Surgical Opinion Expenses. 1. a. This plan pays a benefit for charges of a physician for a second surgical opinion on the need or advisability of performing a surgical or oral procedure for which the charges are a covered medical expense; which is recommended by the first physician who proposed to perform the surgery; and which is non-emergency. Non-emergency means the procedure can be postponed without undue risk to the patient. 2. b. A benefit is also payable for charges made for a third surgical opinion if the second surgical opinion does not confirm the recommendation of the first physician who proposed to perform the surgery. 3. c. A surgical opinion is an exam of the individual; x-ray and lab work; and a written report by the physician who is rendering the opinion. 4. d. The surgical opinion must both be performed by a physician who is certified by the American Board of Surgery or other specialty board; and take place before the date the surgery is scheduled to be performed. 5. e. Surgical opinion benefits are not payable for an opinion if the physician rendering the surgical opinion is associated or in practice with the first physician who recommended and proposed to perform the surgery. 6. f. If, in connection with one of the following surgical procedures when it is non-emergency in nature, a surgical opinion which would be covered under the plan is not obtained before surgery; or the only surgical opinion obtained is rendered by a physician associated or in practice with the first physician who recommended and proposed to perform the surgery; then the benefit payable for the charges incurred for the performance of the surgical procedure under any other part of this plan will be at the rate of fifty percent (50%) after the deductible: Hysterectomy Prostatectomy Knee Surgery Cholecystectomy Tonsillectomy Cataract Removal Adenoidectomy Herniorrhaphy Hemorrhoidectomy Hip Surgery Submucous Resection Laminectomy