210.002 Second Surgical Opinion Program

210.002

Second Surgical Opinion Program: The Texas Medical Association adopted the following guidelines reiterating and amplifying its position on consultations and elective, surgical second opinion programs in Texas:

These guidelines reflect TMA's freedom to express its views on the subject of second opinion programs generally. The guidelines are not binding in any way upon physicians who are members of this association.

(1) TMA fully supports the right of a patient and a physician to seek consultation freely with a consultant of his or her choice. This concept long has been followed by physicians in the interest of providing quality care to the patient. Patients and physicians have sought consultations over the years and continue to do so at this time. To reiterate, TMA fully supports the concept of consultations. It will lend its encouragement to those programs which embrace sound guidelines for quality patient care.

(2) TMA and county medical societies should readily provide information about physicians and list of members to patients and others who desire to secure consultations or to seek second opinions.

(3) The patient should have the right to select the physician of his or her choice for consultations and second opinions. TMA supports the concept of open selection of physicians in the interest of providing the patient with the broadest choice possible in selecting a consultant.

(4) TMA supports the voluntary concept, rather than mandatory approaches, in consultation. Thus, the patient should have the right to accept the evaluation and recommendation of his or her physician, and to choose either to secure or not to secure a second opinion.

(5) TMA respects the right of insurance companies, fiscal intermediaries, and third parties to establish the level of benefits under policies and programs which they offer, in accordance with Texas insurance laws. Similarly, the physician has the right to establish fees for consultations which are reasonable for professional services which he or she has rendered.

(6) TMA supports those provisions in policies offered by insurance companies and programs sponsored by third parties which provide reimbursement for consultations and for second opinions. Nevertheless, TMA does not support the practice of an insurance company or fiscal intermediary in paying a lesser benefit if the claimant has elective surgery without seeking a second opinion. That approach imposes an unfair penalty upon the patient. TMA does not believe that insurance companies should penalize policyholders by paying a lesser amount to those who choose to accept the evaluation of his or her physician, and who do not choose to secure a second opinion.

(7) The primary responsibility of the physician is to the patient. For professional services which are rendered, the physician should have the option, as at present, of billing the patient directly or accepting an assignment for the payment of those services.

(8) TMA agrees that the concept of second surgical opinions is not cost effective (Council on Socioeconomics, p 153-154, I-92; reaffirmed CSE Rep. 3-A-04; reaffirmed CSE Rep. 2-A-14).

Last Updated On

October 07, 2016