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Obtain a second medical opinion: When does the health insurance actually pay?


If in doubt, get a second medical opinion: when does the health insurance company pay?
According to experts, operations are carried out too much and too quickly in Germany. In case of doubt, patients should therefore ask about the necessity before surgery and seek a second opinion if necessary. But who actually pays the cost of visiting another specialist?

There is a lot of surgery in Germany
In recent years it has been repeatedly criticized that too much and too quickly is operated on in German clinics. It is therefore not surprising that more and more patients are getting a second medical opinion. However, many do not even know that they are entitled to this, even though in certain cases the statutory health insurers are even obliged to pay the costs.

Right to a second opinion
The legislator has regulated that the statutory health insurance companies have to cover the costs for a second medical opinion.

However, "a further expert opinion is only granted in the case of operations that can be planned as well as those that are used more frequently for economic reasons than would be medically absolutely necessary", reports the Consumer Advice Center NRW on its website.

“It is not yet clear which interventions are specifically capable of second opinions. Because a directive that lists this is still a long time coming, ”said the consumer advocates.

Inquire at the box office about voluntary benefits
The experts recommend insured persons to inquire about their voluntary benefits from their health insurance company in other cases too - before they get a second opinion.

Because the statutory health insurance companies are allowed to pay their insured persons voluntary medical second opinions for upcoming operations - and some do.

For example, some health insurance companies offer in-house second opinion procedures or provide insured specialists in the required area.

Inform the treating doctor
The consumer advocates also point out that they should inform the attending doctor about this before requesting a second opinion and ask for the delivery of reports, laboratory values ​​and results of X-ray examinations for this purpose.

"This avoids unnecessary and health-damaging double examinations and costs," write the experts.

According to the information, patients have a right to copies of the patient file or the available findings. However, the treating doctor may charge the cost of the copies. (ad)

Author and source information


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