Common use of Second Medical Opinions Clause in Contracts

Second Medical Opinions. Members are entitled to a second medical opinion when disputing the appropriateness or necessity of a surgical procedure, or when subject to a serious injury or illness. a. A Member may choose to obtain a second medical opinion from any Participating or Non- Participating Physician within the Service Area. If a Participating Physician is chosen, the applicable office visit cost-sharing will apply. If a Non-Participating Physician is chosen, Prior Authorization is required, and the Member is responsible for 40% of the amount of the Maximum Allowable Payment associated with consultation. b. Once a second medical opinion has been rendered, AvMed will review and determine AvMed’s obligations under this Contract, and that judgment by AvMed is controlling. Any treatment the Member obtains that is not authorized by AvMed will be at the Member's expense. c. AvMed may limit second medical opinions in connection with a particular diagnosis or treatment to three per Calendar Year, if AvMed deems additional opinions to be an unreasonable over-utilization by the Member.

Second Medical Opinions. Members are entitled to a second medical opinion when disputing the appropriateness or necessity of a surgical procedure, or when subject to a serious injury or illness. a. A Member may choose to obtain a second medical opinion from any Participating or Non- Participating Physician within the Service Area. If a Participating Physician is chosen, the applicable office visit cost-sharing will apply. If a Non-Participating Physician is chosen, Prior Authorization is required, and the Member is responsible for 40% of the amount of the Maximum Allowable Payment associated with consultation. b. Once a second medical opinion has been rendered, AvMed will review and determine AvMed’s obligations under this Contract, and that judgment by AvMed is controlling. Any treatment the Member obtains that is not authorized by AvMed will be at the Member's expense. c. AvMed may limit second medical opinions in connection with a particular diagnosis or treatment to three per Calendar Yearcalendar year, if AvMed deems additional opinions to be an unreasonable over-utilization by the Member.

Second Medical Opinions. Members are entitled to a second medical opinion when disputing the appropriateness or necessity of a surgical procedure, or when subject to a serious injury or illness. a. A Member may choose to obtain a second medical opinion from any Participating in-network or Non- Participating out-of- network Physician within the Service Area. If a Participating an in-network Physician is chosen, the applicable office visit cost-sharing will apply. If a Nonan out-Participating of-network Physician is chosen, Prior Authorization is required, and the Member is responsible for 40% of the amount of the Maximum Allowable Payment associated with consultation. b. Once a second medical opinion has been rendered, AvMed will review and determine AvMed’s obligations under this Contract, and that judgment by AvMed is controlling. Any treatment the Member obtains that is not authorized by AvMed will be at the Member's expense. c. AvMed may limit second medical opinions in connection with a particular diagnosis or treatment to three per Calendar Yearcalendar year, if AvMed deems additional opinions to be an unreasonable over-utilization by the Member.