If an insurance company asks for a second opinion, amI responsible for the cost?

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If an insurance company asks for a second opinion, amI responsible for the cost?

my doctor suggested a hysterectomy. My insurer wouldn’t approve without a second opinion. Now I have a $1,000 bill from the second doctor. Should I have to pay it?

Asked on October 2, 2011 under Insurance Law, Missouri

Answers:

MD, Member, California Bar / FreeAdvice Contributing Attorney

Answered 9 years ago | Contributor

Your insurance should cover your medical consultations but if this second opinion is from a doctor who is not within your insurance network and not on the insurance provider list, then you are unfortunately stuck with this bill for now. However, if it was your impression that your second opinion doctor accepted your insurance, and the insurance forced you to go to that doctor, you have a case. You should contact your state's insurance agency that regulates these insurance companies and file a consumer complaint to see if the insurance company would cover your $1,000.00 bill as a result of the bad faith the entity committed by a) forcing you to get a second opinion and b) not covering your bill from the second doctor. However, $1,000.00 seems a bit high for a consultation so make sure you also converse with the doctor's office about why you received this bill and why for so high.


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