New Claims System Update

6.3 Second Medical or Surgical Opinion

Provider Manual
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6 PROVIDER NETWORK INFORMATION

6.3 Second Medical or Surgical Opinion

Members may request a second opinion if they:

  • Dispute the reasonableness of a decision.
  • Dispute the necessity of a procedure decision.
  • Do not respond to medical treatment after a reasonable amount of       time.

    • To receive a second opinion, members must:

  • Obtain a second opinion from a provider within the IntegraNet        network.
  • Be responsible for the applicable copay.