Insurance question - second, third opinions

[Rachel]

Hi, I'd rather not call my insurance company yet since I don't have a diagnosis "code" or a surgery date yet, but here's my question.

We have a PPO that requires a $20 copay for doctor's visits, and has a maximum deductible of $1,200 or something per person. Am I "allowed" to get a second opinion with a PPO? In other words, does the insurance company question why there are two or three neurosurgeons and/or plastic surgeons in various cities that were seen/consulted with?

ALSO - when you get a second opinion and it's in another city - do NS or PS ever just ask to see (only) the CAT scan vs. the child himself? My 5 week old supposedly has a metopic suture although the CAT scan results still need to be shared with me.

Thank you for any insight.

[Katie]

I wish I could answer that for you, but it really depends on the individual insurance policy. A PPO is the type of insurance where you don't have to get a referral to go see a specialist, right? For out of state you would need to see what your in/out of network policies are. I believe some PPO's cover less out of state. Can you call them and ask what their out of network policy is rather than asking about a second opinion directly, or do they have a website explaining out of network benefits?

For the CT results, you can go to the radiology department where you had them done and pick up a copy. Usually if you call ahead they will have it ready for you, and make sure you ask them for a copy of the radiologists report to. I can usually pick up Dillon's about 48-72 hours after the exam.

Hope this helps some :hugg

[laurensmom]

I would call your insurance and just ask them. Get names and extensions if possible and if you don't like the answer ask for a supervisor. I am a pain in the butt to my insurance company. I constantly petition my bills because we have such a high deductable. I have saved myself tons of money by questioning everything. But if you get an answer you like make sure you take the persons name and number...this will be VERY helpful if you get billed for something they said you wouldn't. Don't worry about bothering them..that is what they are there for. We went to three doctors for Lauren's eye and they paid for all of them.

[Melissa]

Most PPO's will pay for a second opinion as long as it's with an in-network provider. I'd still call and double-check with them before hand, and find out if you need an approval before the appointment since it is a second opinion. If the particular doctor is out-of-network, find out how much they will be willing to pay, and if there is any way to get it paid at a better rate. Find out if you qualify for a special case worker - sometimes you can get one person to handle most/all of your child's insurance issues and they can sometimes push to get certain things covered, or covered better, that might not be ordinarily. Good luck!

[Rachel]

Thank you everybody. This was good info.