Are Costs Incurred For Availing A Second Medical Opinion Covered By Health Insurance?

It might be frightening when you or anyone in your family is diagnosed with a serious, life-threatening disease and the doctor asks you to undergo an expensive surgery/ treatment. You might have many questions in your mind. Should you go ahead with the expensive treatment that your doctor has recommended? Or, is there an alternative treatment that you can undergo? 

And hence, the need for a second medical opinion arises. While seeking a second medical opinion could be the right thing, getting the availability of a senior/reputed doctor within the limited time at hand could be a challenge. Plus, this could also mean additional expenses not only on doctor’s consultation but also the repeat examinations that the doctor might advise. But this wouldn’t be much of a problem if the costs were covered by health insurance, would it? 

So, are the expenses incurred while getting a second medical opinion covered by health insurance policy in India? Yes, they are! The expenses of getting a second medical opinion are covered by some health insurance policies in India. The coverage, however, is subject to certain conditions. 

We’ll learn about these conditions in this article. Before that, let’s understand what a second medical opinion actually means and when you should seek one.

What Is A Second Medical Opinion?

A second medical opinion is an additional opinion you get from a doctor or a medical practitioner, other than the one treating you, for an illness or an injury that you’re diagnosed with.  

When Should You Seek A Second Medical Opinion?

Taking a second medical opinion might be a good idea if you’re diagnosed with a serious, life-threatening, or rare, complex disease that requires you to undergo a costly treatment with high-risk factors. 

You could also seek a second medical opinion if you need more information about a diagnosis or a treatment recommended by your doctor or if you’re unsure about how a particular treatment/ surgery might work or benefit you.

Second Medical Opinion Benefit in Health Insurance

If your health insurance policy offers a second medical opinion benefit, you can get an additional consultation from a second doctor other than the treating doctor - without paying any extra charges. You can use this benefit once in a policy year.

Some insurers allow you to seek a second opinion by physically visiting and consulting the doctor whereas some insurers provide you the facility of obtaining an e-medical opinion. Further, while some insurers allow you to get an opinion from a doctor residing only in India, there are insurers who allow you to get an opinion from an international doctor too.

This will all majorly depend on the health insurance product that you buy.

How Is The Second Doctor Chosen?

Whether the second doctor is chosen by you or the insurance company - varies from insurer to insurer. 

If it’s mentioned in your policy that you can take a second opinion from any medical practitioner, then you can submit your medical reports and the required documents and consult any doctor other than the one currently treating you. 

If it is mentioned in the policy document that you’ll have to choose the second doctor from the insurance company’s empaneled network of medical practitioners, then this is the process you’ll have to follow - 

• You’ll have to raise a request for a second medical opinion with your insurance company via email or their toll-free helpline.
• The insurer will submit your medical reports and other documents to a doctor chosen from the insurer’s empaneled network of medical practitioners either online or through post or courier.
• The second doctor will examine your reports and medical documents and send you the results of their opinion directly.

Which Illnesses & Injuries Can You Seek A Second Medical Opinion For?

The answer to this question will depend on the health insurance product you purchase.

Some insurers allow you to use this benefit for any illness or injury you're availing treatment for, others mention a list of major illnesses and injuries you can take a second medical opinion for. There are also insurers who only allow you to use this benefit for critical illnesses listed in the policy document.

So, ensure you go through your health insurance policy wordings before making the purchase so that you’re aware of the illnesses or injuries you can use this benefit for.

Conditions for Coverage of Second Medical Opinion under Health Insurance

In India, a second medical opinion will be covered by health insurance only if certain conditions are fulfilled. Please note, that these conditions might vary across insurance companies. 

1️⃣ The opinion will be provided only on the basis of reports 

When you get a second medical opinion for any illness or injury, the second doctor or medical professional that will provide the opinion will have to do so without examining the patient. They will have to give recommendations solely on the basis of the medical reports and documents. 

2️⃣ The claim must be approved for inpatient hospitalization

You can use this benefit only if your medical condition is eligible to be treated under inpatient hospitalization, that is - you’re admitted to a hospital for 24 hours or more and the insurance company has approved a claim under the inpatient benefit. 

3️⃣ The opinion received won’t be valid for medico-legal purposes

When you seek a second opinion, the insurance company won’t be liable in case of any consequences or damages that arise out of or in relation to that opinion. You cannot sue or file a complaint against the insurance company for a second opinion you’ve received for any treatment/ surgery. 

That is all about the second medical opinion benefit under health insurance. Hope you found this article helpful. Do let us know what you’d like to read about next, in the comments section below - and we’ll get right on it!

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