Second Medical Opinions Sample Clauses
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. 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.
a. A Member may choose to obtain a second medical opinion from any Participating or Non- Participating Physician within the Service Area. If a Participating Physician is chosen, the applicable office visit cost-sharing will apply. If a Non-Participating Physician is chosen, Prior Authorization is required, and the Member is responsible for 40% of the amount of the Maximum Allowable Payment associated with consultation.
b. Once a second medical opinion has been rendered, AvMed will review and determine AvMed’s obligations under this Contract, and that judgment by AvMed is controlling. Any treatment the Member obtains that is not authorized by AvMed will be at the Member's expense.
c. 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. 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.
a. A Member may choose to obtain a second medical opinion from any Participating or Non- Participating Physician.
b. Once a second medical opinion has been rendered, AvMed will review and determine AvMed’s obligations under this Contract, and that judgment by AvMed is controlling. Any treatment the Member obtains that is not authorized by AvMed will be at the Member's expense.
c. 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. 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.
a. A Member may choose to obtain the second medical opinion from any Participating or Non- Participating Physician. If a Participating Physician is chosen, the applicable office visit cost-sharing will apply. If a Member chooses a Non-Participating Provider, the Member will be responsible for 40% of the amount of the Maximum Allowable Payment for the second medical opinion.
b. Once a second medical opinion has been rendered, AvMed shall review and determine AvMed’s obligations under this Contract and that judgment by AvMed is controlling. Any treatment the Member obtains that is not authorized by AvMed shall be at the Member's expense. 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. 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. ▇▇▇▇▇▇'▇ decision to ▇▇▇▇▇ 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 ▇▇▇▇▇▇ at 1-800-321- 2843, or by writing to: ▇▇▇▇▇▇ Professional Counseling Centers, Care Management Department, PO Box 8011, Canoga Park, CA 91309.
Second Medical Opinions. The Sick Leave Bank Committee and/or the Superintendent may require additional medical information or a second medical opinion of a Bank applicant. This requirement for additional information must be made prior to the decision of the Sick Leave Bank Committee on the applicant's request or prior to extension of the leave by the Sick Leave Bank Committee, whichever is applicable. Any necessary medical opinions are the expense of the applicant.
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.