Getting a Second 

Opinion Before Surgery 

Your Choices and Medicare Coverage 

What is a second opinion? 

A doctor may tell you that you need surgery 

for a health problem that is not an 

emergency. This means that the surgery 

does not have to be done right away. That 

means you have time to talk with your 

doctor and decide what is best for you. 

Deciding what is best for you could be 

getting a second opinion from another 

doctor. A second opinion is when another 

doctor gives his or her view about your 

health problem and how it should be 

treated. 

Doctors do not always agree on when 

surgery is the best choice of treatment. You 

have the right to: 

• Know what your choices are. 

• Have another doctor look at those 

choices with you. 

• Have your wishes considered before 

choosing surgery. 

When should I get a second

opinion? 

Do not wait for a second opinion for 

emergency surgery. Some types of 

emergencies that may require surgery right 

away include: 

• Acute appendicitis 

• Blood clot or aneurysm 

• Accidental injuries 

It is up to you to decide when and if you 

will have non-emergency surgery. Getting a 

second opinion can help you make a more 

informed decision. For example, the 

following procedures are not always 

emergencies: 

• Tonsillectomies 

• Gall bladder procedures 

• Hysterectomies 

• Hernia repairs 

• Cataract operations 

You may also get a second opinion if your 

doctor tells you that you should have 

certain kinds of major non-surgical 

diagnostic or therapeutic tests. 

How do I get a second opinion? 

When you decide you want a second 

opinion, ask your doctor’s office to send 

your medical records to the doctor giving 

the second opinion. That way, you may not 

have to repeat medical tests. 

Before you visit the second doctor, call that 

office and make sure they have your 

records. During the visit, be sure that the 

doctor knows what tests you have had and 

what surgery you want to discuss. 

If the second doctor does not agree with the 

first, you may feel confused about what to 

do. In that case, you may want to: 

• Talk about your condition more with your 

first doctor. 

• Talk to a third doctor. 

Publication No. HCFA–02173 

May 2000 
What do I need to know before I 

get a second opinion? 

When surgery is not an emergency, you may 

want to ask the doctor questions about your 

health problem and the surgery. It may help 

to write down a list of questions. Take the 

list of questions with you to the doctor. To 

help you with making your list of questions, 

you may want to call 1-800-MEDICARE (1-

800-633-4227), and ask for Choosing 

Treatments. 

How do I find a doctor to give

me a second opinion? 

• Ask your doctor for the name of another 

doctor to see. Do not hesitate to ask; 

most doctors want you to get a second 

opinion. If you do not want to ask the 

doctor who recommends the surgery, ask 

another doctor you trust for the name of a 

doctor to see for a second opinion. 

• Ask your local medical societies for the 

names of doctors who treat your illness or 

injury. Your local library can help you 

identify these societies. 

• Call the Medicare carrier who handles 

your Medicare Part B bills. Your carrier 

can give you the names of doctors in your 

area who accept assignment (accept the 

Medicare approved amount as payment in 

full). This could save you money. For 

additional information on "assignment", 

refer to the Medicare pamphlet: Does your 

doctor or supplier accept "assignment?". 

To find your Carrier's name, address, and 

telephone number: 

• Look in the Medicare & You handbook. 

• Call 1-800-MEDICARE (1-800-633-

4227) or TTY/TDD: 1-877-486-2048 for 

the hearing and speech impaired. 

• Look on the internet at www.medicare.gov 

under "Helpful Contacts." 

How does Medicare pay for a

second opinion? 

Medicare Part B helps pay for a second 

opinion just as it helps pay for other doctors' 

services that are medically necessary. 

If you have Medicare Part B and are in the 

Original Medicare Plan: 

• Medicare pays 80 percent of the approved 

amount for a second opinion. Your share 

is usually 20 percent of the Medicare 

approved amount, after you have paid 

your $100 annual Part B deductible. 

• If the second opinion does not agree with 

the first, Medicare pays 80 percent of the 

approved amount for a third opinion. 

If you are in a Medicare managed care plan 

(such as an HMO), you have the right to 

get a second opinion. But some plans will 

only pay for a second opinion if you first get 

a referral from your primary care doctor. (A 

referral is a written OK). You must get the 

second opinion from the doctor named in 

the referral. If you want to get a second 

opinion from a doctor who does not belong 

to your plan, talk to your plan first. Some 

plans will pay if you do this, but most will 

not. 

If you are in a Private Fee-for-Service plan a 

second opinion for your health problem is 

covered by Medicare. If the first two opinions are different from each other, the 

Private Fee-for-Service plan will pay for a 

third opinion. 

If you have Medicaid, it may also pay for 

second surgical opinions. To find out, 

contact your State medical assistance office. 

You can get the phone number by: 

• Looking in the Medicare & You handbook. 

• Calling 1-800-MEDICARE (1-800-633-

4227) or TTY/TDD: 1-877-486-2048 for 

the hearing and speech impaired. 

• Looking at www.medicare.gov. under 

"Helpful Contacts."