354.207. Second medical opinion to be allowed by health services corporations, procedure, costs. - Missouri Statutes

Second medical opinion to be allowed by health services corporations,procedure, costs.

354.207. 1. A health services corporation shall allow enrollees toseek a second medical opinion or consultation from a willing secondphysician at no additional cost to the enrollee beyond what the enrolleewould otherwise pay for an initial medical opinion or consultation fromthat second physician.

2. If an enrollee chooses to seek a second medical opinion, and ifthe health services corporation does not employ or contract with anotherphysician with the expertise necessary to provide a second medical opinion,then the health services corporation shall arrange for a referral toanother physician with the necessary expertise to provide a second opinionor consultation and ensure that the enrollee obtains the covered benefit atno greater cost to the enrollee than if the benefit were obtained fromparticipating physicians.

3. The second opinions required in this section and section 354.546shall be covered only in the event that the original diagnosis requiresmajor surgery or other treatment necessitating general anesthesia or otherserious illness involving loss of bodily part or function or otherdebilitating disease.

(L. 1998 S.B. 754 § 354.207, § 1)