Medicare Wants Your Treatment To Be Effective & Efficient

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Always ask for a second opinion – it’s covered, and Medicare wants to help you!


Fred’s doctor says he needs surgery to correct a hiatal hernia. Alice has just received a diagnosis of cancer. Ray’s doctor believes his heart disease needs surgical treatment. None of these are conclusions that anyone wants to hear. After the initial dismay at the news, what do they do then? What should you do? Medicare wants to assist.

If you have received a diagnosis that requires either surgery or major non-surgical procedures, you should immediately go into research mode. Find out everything you can about your disease or condition and what successful treatment is recommended.

Discuss the process and expected outcome with your doctor. Then, get a second opinion. Medicare covers it and actually suggests that you do it. Many people hesitate to get a second opinion because they are afraid their original doctor will be insulted. The fact is, if he or she is a good doctor, a second opinion will be welcomed.

Check on to confirm that your disease or condition is covered for second opinions. There is a function on the site where you can enter your diagnosis and find out if it’s covered.

Medicare wants you to make a good choice.

Find an expert for a second opinion

Find a physician who has experience with your condition and has successfully treated others for it. Physicians who are associated with teaching or research hospitals are more likely to be up on the latest developments in the field. Your doctor may be able to recommend someone. If not, you can find the names of appropriate doctors, usually with feedback from patients, online.

When you identify a physician for a second opinion, make sure that he or she accepts Medicare.

Have your records sent from your original doctor to the second-opinion doctor. Show up with a list of questions to learn everything you can about your condition and about all alternative treatments. You may want to take a friend or relative with you not only for emotional support but to provide another set of ears in the conversation.

Treatment must be medically necessary and non-emergency

Second opinions are covered by Medicare for medically necessary, non-emergency treatment. Cosmetic surgery and other elective surgeries are not covered.

If your situation requires emergency surgery, such as acute appendicitis, do not try to get a second opinion. If there is a delay, it may put your health and life at risk.

You will pay 20 percent of the approved Medicare amount for secondary opinions and your deductible will apply. The second-opinion service is covered under Medicare Part B.

If you have a Medicare Advantage plan, check with your provider. Second opinions are usually covered by may require a referral from your original doctor. Medicare does not require this.

Medicare wants you to get answers.

What happens when two doctors disagree?

If the diagnosis and recommended treatment from your second-opinion doctor is very different from those of your original doctor, you may seek a third opinion. This will also be covered by Medicare, as well. You will then decide among the three which one you want to conduct the surgery or treatment.

Above all, you want to confirm your diagnosis and understand all the treatment options. The more informed decisions you make, the greater the odds of a successful outcome.

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