Using Your HMO Option
You may ask your primary care physician to refer you to another doctor for a second opinion if:
- There is a question about your diagnosis, plan of care or recommended treatment, including surgery
- Additional information about your condition would help to determine the diagnosis and the most appropriate treatment plan
- The current treatment plan is not improving your medical condition
To get a second opinion under your HMO option, you will need a referral from your primary care physician. If you request a second opinion about care you received from your primary care physician, the second opinion will be provided by a physician within the same medical group or Independent Practice Association (IPA) as your primary care physician.
If you request a second opinion about care you received from a specialist, this second opinion can be provided by any specialist of the same or equivalent specialty within our HMO network.
You will need to call the Member Services number on your Blue Shield ID card to request a second opinion about care you received from a specialist when the specialist is outside your assigned medical group or IPA.
Your primary care physician might also decide to offer a second opinion referral even if you don't request one.
A second opinion will be provided on an expedited basis, when appropriate. California law requires that health plans disclose to members, upon request, the timelines for responding to a request for a second medical opinion.
To request a copy of these timelines, please contact us.
Using Your PPO Option
Using your PPO option gives you the flexibility of seeking a second opinion without obtaining a referral from your primary care physician. You also have the option of seeking a second opinion from a physician who is not in our preferred provider network.
To keep your medical costs down, it's wise to seek a second opinion within our preferred provider network.
Under your PPO option, your copayments for second opinion office visits are the same as those for other non-preventive, non-emergency physician office visits.