What must an insured do when a health insurance policy includes a Mandatory Second Surgical Opinion provision?

When a health insurance policy includes a Mandatory Second Surgical Opinion provision, it requires the insured to seek a second opinion for specified elective surgeries. This provision is designed to ensure that the proposed surgical intervention is medically necessary and appropriate. The goal is to prevent unnecessary surgeries, which can be costly and involve significant risks for the patient.

By requiring a second opinion, the insurance company aims to confirm the initial diagnosis and treatment recommendation made by the primary physician. The process typically involves the insured consulting a different qualified healthcare provider who can review the case and offer their perspective on the necessity and type of surgery being contemplated. This step helps to enhance patient safety and promotes informed decision-making regarding health interventions.

In contrast, seeking a waiver for elective surgeries, consulting a physician of choice, or scheduling a follow-up appointment do not specifically address the requirement set out by the Mandatory Second Surgical Opinion provision. These actions do not fulfill the intent of providing a necessary secondary evaluation before proceeding with elective surgical procedures.