April 1998

Second Medical Opinions for Cancer

Under a law passed in 1997, health plans regulated by New York State must pay for a second medical opinion for a patient who thinks they may have cancer or who has a confirmed cancer diagnosis. The law becomes effective for different health insurance policies on different dates starting with January 1, 1998. Check with someone knowledgeable about your health plan to see when it applies to you.

Under the new law, if a patient is in a health plan under which they must receive care from the plan's network of physicians and they want to get a second opinion from a doctor outside of the network, the patient must first get the permission of their attending physician.

The new law expressly authorizes a patient's in-network physician to refer the patient to a hospital or other facility which specializes in the treatment of cancer even if the facility is not part of the plan's network so be sure to discuss this option if you are in a plan under which you are normally required to receive care from the plan's network of  providers.

Second medical opinions can be subject to copays and deductibles so find out in advance from your insurer how much the opinion will actually cost you.

The right to a second medical opinion is set forth in the following sections of the New York Insurance Law. Each section applies to a different type of health plan.

Insurance Law section 3216(19) (individual policies)

Insurance Law section 3221(k)(9) (group and blanket policies)

Insurance Law section 4303(w) (policies issued by Empire Blue Cross and Blue Shield and similar insurers)

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