Are Second Medical Opinions Covered By Health Insurance?

Whenever someone in your circle gets diagnosed with an illness, you must have heard people say, “You should get a second opinion to confirm what the doctor has said. Maybe there is an alternate or less expensive treatment route!”

The development of advanced medical facilities is a ray of hope, especially in cases of life-threatening diseases like cancer. Nevertheless, sometimes you may be in a dilemma if you are not comfortable with the treatment options recommended by your current doctor. In such cases, it would be wise to seek a second opinion.

While a second opinion is an effective way to confirm the prognosis and the treatment required, it might be heavy on your pocket since you’ll need to go through the entire process again - doctor consultation fees, charges for medical tests, etc.

So, what can be done? Health insurance to your rescue! Some health insurance policies in India cover second medical opinion costs. However, they may be subject to certain conditions.

Let’s take a look at what a second medical opinion is, when you should get it, what illnesses are covered by your health insurance, and more - in this article.

All about Second Medical Opinion in Health Insurance
  • What Is A Second Medical Opinion?

    It is an additional opinion you seek from a doctor or medical practitioner besides the one treating you for a diagnosed illness or injury.

  • When Should You Get A Second Medical Opinion?

    It's common to go with what your doctor says when dealing with small health issues. But, when it comes to critical illnesses, you should get as much information as possible about the diagnosis, treatment, dietary requirements, medicine side effects, etc - to be extra sure of what you (and your wallet) will be going through.

    For instance, Manisha is diagnosed with 3rd stage ovarian cancer. Her doctor recommends an immediate surgery followed by chemotherapy. Since the treatment involves long-term side effects, she decides to seek a second opinion from another doctor to know whether she's on the right track. In this case, her health insurance will cover the costs incurred for the second medical opinion.

Benefit Of Second Medical Opinions In Health Insurance

If your health insurance policy provides a Second Medical Opinion Benefit, you can get additional consultation from a doctor at no extra cost.

This benefit can be used once every policy year.The benefits associated with the second opinion Cover vary across products

Some insurers permit you to seek a second opinion by visiting the doctor in person, while others allow you to speak with the doctor online.

Some insurers allow you to consult a doctor based in India, while others allow you to consult international doctors too.

Who Chooses The Second Doctor?

This differs across insurance companies -

If Your Policy States You Can Choose Any Doctor -

You are required to submit your medical records and the required documents before consulting them.

If Your Policy States You Need To Choose A Doctor From Their Network Of Doctors -

You need to follow these steps -

Contact your insurance company to request a second medical opinion via email or their toll-free helpline.

Your insurer will send your medical reports and other documents to a doctor selected from its affiliated network either by email, post, or courier.

You will receive a direct response from the second doctor after they have examined your reports and medical documents.

Illnesses And Injuries Eligible For A Second Medical Opinion

Some insurers allow you to use this benefit for any illness or injury you are seeking treatment for, while others outline a list of major illnesses and injuries which qualify for the Second Opinion Cover. Some insurers may further limit this benefit to the list of critical illnesses, as specified in the policy documents.

Go through the health insurance policy wordings before making the purchase to ensure that you know what illnesses and injuries the benefit covers.

Illness and Injuries eligible for a Second medical opinion
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Conditions For Coverage Of Second Medical Opinion Under Health Insurance

The cost of a second medical opinion is covered by health insurance only when certain conditions are met.

  • Approval Of Inpatient Hospitalisation Is Required

    Your medical condition must be eligible for inpatient hospitalisation, which means that you must be admitted to the hospital for 24 hours or longer and your insurance company must approve your claim under inpatient hospitalisation.

    For instance, Rachel is diagnosed with gallstones and is admitted to the hospital for treatment. Her doctor advises her to undergo gallbladder removal surgery. However, she is not comfortable with surgery and wants to know whether this condition can be treated with medication. She decides to get a second opinion from another doctor. She has been admitted in the hospital for more than a day (more than 24 hours), and therefore, is eligible for second opinion medical cover.

  • Second Opinions Are Based Only On Medical Reports

    Whenever you seek a second medical opinion for a medical condition, the second doctor or medical professional will not physically examine you. They will be able to give guidance only based on medical documents and reports.

  • Insurer will Not Be Liable For Legal Consequences

    Your insurance company won't be held accountable for any issues or complications arising out of a second opinion. You cannot take legal action or file a complaint against the insurance company.

This is an indicative list of conditions. They may vary across insurance companies.

exclusion of health insurance plans
Not Covered In Health Insurance
  1. Pre-existing Deceases for a Fixed Term
  2. Cosmetic Surgeries
  3. Injuries caused due to suicide attempts

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Summing Up!

A second medical opinion is an effective way to know more about your condition and confirm the established diagnosis and advised medical treatment. Make sure your health insurance policy covers second opinions, because illnesses are uninvited and unpredictable. And, read through your policy document carefully to be aware of the conditions associated with this coverage.

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