Medicare will pay for you to see a doctor and get a second opinion if:
- a doctor has recommended that you have surgery or a “major diagnostic or therapeutic procedure.”
Medicare will pay for a third opinion if:
- the first and second opinions are different. The second and third opinions will be covered even if the surgery or other procedure is determined not to be covered.
If you want a third opinion but the first and second opinions were the same:
- you may be able to see a third doctor for a “confirmatory consultation.” Your insurance company may consider a “consultation” different from a third-opinion visit because it is done at the request of the patient. Medicare may cover the consultation as long as the third doctor submits a claim using the right code and writes in your medical record that the services provided were reasonable and medically necessary.
Note: If you are in a Medicare private health plan, your plan may have different rules about second and third opinions. The plan may only cover second and third opinions if you see doctors that are in network, or if you have a referral from your Primary Care doctor. Call your plan to find out the rules for getting second opinions.