How Do I Get a Second Opinion Without a Referral?

Second opinions used to be required by insurance companies before they’d approve surgeries and other forms of treatment. Today, many plans now allow you to seek a second opinion at any time for any reason without needing a doctor’s referral to schedule an appointment.

Even if you don’t need the greenlight from your primary care provider to see a specialist or other medical professional for another perspective, it’s a good idea to ask yours — along with trusted friends and family members — for the names of practitioners you can trust.

You should consider seeking another point of view if you have a complex medical condition, a rare or life-threatening health issue, or if your symptoms don’t improve after you follow a recommended treatment plan.

“For a lot of patients, I think it’s a good idea to get a second opinion to see a specialist if you are unsure of your diagnosis or treatment plan,” says Susan Lee, MD, the medical director of Stony Brook University’s primary care department in Stony Brook, New York.

“Trust your gut instinct,” says Dr. Lee. “You have to have a good relationship with your physician, and it has to be someone you trust. If you don’t click, it’s not unreasonable to see someone else.”

“As a primary care physician, there is a certain network of specialists I like to use,” says Lee.

Typically, a PCP will initiate the referral process by selecting the appropriate specialist and coordinating with the office for an appointment to be scheduled. It’s a good idea to check with your health insurance plan to make sure the recommended doctor is a part of your health insurance provider network, to manage your costs.

Your primary care physician’s office is also a great resource to help you find physicians if you don’t need a referral for insurance reasons, since they’re familiar with your health history and can steer you in the right direction, says Lee. “A patient may think they need to see a neurosurgeon when they may need to see a nonsurgical expert,” she says.

In addition, your PCP can ensure that you’re seeing a trusted expert. “I don't recommend getting second opinions from specialists who have not been vetted, since online reviews can be fabricated,” says Lee.

Virtual second opinions are another option. Those allow you to connect with doctors and specialists without leaving home. But the quality of care at virtual visits can vary.

“I am not a big fan of the virtual companies where there is no office, and you can’t see the physician,” says Lee. “I am a firm believer in being able to talk to a practitioner in person, but virtual visits and second opinions are appropriate for some health conditions.”

Start by reviewing the denial letter to find out why it wasn’t approved, then you may want to gather more evidence from the original doctor to strengthen your case. Health insurance companies have different appeals processes, so be sure to follow the specific rules for your plan.

“It’s important to be connected with your portal,” says Lee. “But if you need to request records from your doctor’s office, you also have the ability to do that. It’s really important to have those records for the next medical appointment.”

• Whether a referral is required for a second opinion depends on your specific health insurance plan. It’s often possible to seek another medical opinion without a referral.
• It’s a good idea to seek another opinion if you have a complicated medical condition, a rare or potentially deadly health issue, or if your symptoms don’t go away after you follow the advice of the original doctor.
• Whether or not you need a formal referral for your insurance company to cover the second opinion visit, it’s a good idea to ask your primary care provider for specialist suggestions so you know the expert is vetted.