Second Opinion by a Physician

Provider Type

  • Physicians 
  • Participating Physician Groups (PPG)

Second opinion consultations related to member's medical need for surgery or non-surgical diagnostic or therapeutic procedures are a covered benefit. Second opinion consultations include a history, an examination and a medical decision of some complexity. Whether a second opinion request is in-network or out-of-network, an organization determination (applicable to Medicare Advantage only) must be requested. Additionally, office visits, consultations with participating physicians, or referrals to physicians or qualified professional providers necessary for obtaining a second opinion are covered and subject to scheduled copayments if applicable.

Prior authorization may be required for surgery or for a major non-surgical diagnostic or therapeutic procedure, except in an emergency. A member may contact their primary care physician (PCP) or Health Net Member Services to request authorization for a second opinion.