Right to a second opinion
All members have the right to a second opinion. Coverage for the second opinion is for evaluation and consultation and does not guarantee that the services or treatments recommended by the physician providing the second opinion will be covered. Coverage is determined by the member's Evidence of Coverage.
When requested or indicated and provided by physicians within the Kaiser Permanente network, a service may be covered when approved in advance. "Approved in advance" means a Kaiser Permanente physician has requested prior authorization and the member has received written approval from Kaiser Permanente.
Coverage of second-opinion visits:
Is determined by the member's Evidence of Coverage.
Does not imply that the member's plan will cover the recommended services or treatments.
Does not imply that we will approve ongoing care with physician providing the second opinion.
The referring Kaiser Permanente physician must initiate any diagnostic or therapeutic services. We do not cover services, drugs, and devices that are prescribed or recommended as a result of the consultation unless they are covered in the member's Evidence of Coverage and approved by the health plan in advance of receiving the service.
The Kaiser Permanente physician reviewer will conduct a clinical review for second opinion requests beyond the initial approval on a case-by-case basis.
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