Getting a Medical Second Opinion: Costs, Rights & How to Pay for It (2026)

A second medical opinion is one of the most valuable — and underused — tools available to patients. A landmark Mayo Clinic study found that 21% of patients who sought a second opinion received a different or refined diagnosis. Another study found that 30% of patients who sought a surgical second opinion avoided surgery entirely, saving an average of $18,000. Here is when to get one, what it costs, and how to pay for it.

1. When to get a second opinion

A second opinion is appropriate — often essential — in any of these situations:

2. What insurance covers

Second opinion visits are generally covered the same as any specialist visit under most health plans:

• Commercial insurance (employer-sponsored or marketplace): Covered as specialist visit — typically $30–$75 copay or subject to deductible. Requires referral only if your plan requires referrals for all specialist visits (common in HMOs).
• Medicare: Part B covers second opinions for surgery at 80% after the Part B deductible. If you're unsure about a diagnosis that might require surgery, Medicare explicitly covers a second and even a third opinion.
• Medicaid: Varies by state, but most state plans cover second opinions as specialist visits.
• Plans that require second opinions: Some employer plans and HMOs require second opinions before approving elective surgery (particularly joint replacement, spine surgery, bariatric surgery). In these plans, getting a second opinion is a prerequisite for coverage — not optional.

Online second opinion services (Mayo Clinic Online, Cleveland Clinic MyConsult) are inconsistently covered. Some insurers cover them as a specialist consultation; others exclude them as "non-covered remote services." Call your insurer before using an online service and ask: "Is an asynchronous online second opinion consultation covered as a specialist visit?"

3. Centers of Excellence programs

One of the best-kept secrets in employee benefits: Centers of Excellence (COE) programs that some large employers negotiate directly with top medical centers:

COE programs typically cover travel, lodging, and a companion's expenses as well. For a major surgery or cancer treatment, a COE program can save tens of thousands of dollars in both procedure costs (the employer negotiated rates far below market) and travel expenses.

How to find yours: Check your employer benefits portal under "Centers of Excellence," "Specialty Care," or "Case Management." Contact your HR benefits team directly. Many employees are unaware this benefit exists.

4. Online second opinion services

Several major medical centers offer remote, asynchronous second opinion services where you submit records electronically and receive a written report from a specialist:

• Mayo Clinic Online Second Opinion: $1,500–$3,500 depending on complexity. Not always covered by insurance. Written report within 2 weeks. Access to Mayo subspecialists in every specialty.
• Cleveland Clinic MyConsult: Pricing varies by specialty ($565–$3,000 range). Similar format — submit records, receive specialist written report. Some insurers reimburse as specialist consultation.
• Johns Hopkins, Mass General, Brigham and Women's: Similar programs available at varying price points.
• Teladoc Expert Medical Opinion: Sometimes covered through employer health plans at no additional cost; bundled into some large group plans. Worth checking your plan documents.

Online second opinions are particularly valuable for: rare diseases where no local experts exist, when travel is prohibitive, when you need an opinion quickly before starting treatment, and for confirming a community diagnosis before committing to major surgery.

5. How to get a second opinion (step by step)

1. Request your medical records. Under HIPAA, you have the right to your records within 30 days. Request: the relevant visit notes, all imaging and pathology reports (not just the readings — the actual images on a CD or digital download), lab results, operative notes if surgery has occurred, and the original diagnosis report. See our medical records guide for the full process.
2. Identify the right specialist. For cancer, seek an NCI-designated cancer center (there are 72 in the US). For rare diseases, seek a university medical center with a program in your specific condition. For surgical second opinions, seek a board-certified specialist in the relevant subspecialty at a high-volume center.
3. Check your insurance network. Confirm the second-opinion provider is in-network or that your plan covers out-of-network second opinions. For PPO plans, out-of-network coverage typically applies at higher cost-sharing.
4. Book the appointment. When calling, say: "I'm seeking a second opinion on a [diagnosis/surgery recommendation]. I have records I can send in advance." Most academic centers and specialists accommodate second opinion requests routinely.
5. Send records in advance. Don't arrive with records in hand — ship them at least 5 business days before the appointment so the second-opinion physician can review them fully before seeing you.
6. Prepare your questions. Write down: What is the confirmed diagnosis? What are all treatment options? What would you recommend and why? What are the risks and expected outcomes? Are there clinical trials I should consider?
7. Compare the opinions. If the second opinion confirms the first, you can proceed with confidence. If it differs, consider a third opinion or a case conference where both physicians discuss your case.

6. Surgical second opinions specifically

Surgery warrants a second opinion more than almost any other medical recommendation. The stakes are high — procedures are irreversible, risks are real, and there is often more clinical discretion than patients realize:

• Joint replacement (knee, hip): Rates vary 3–4 fold across geographic regions, suggesting significant clinical discretion. Non-surgical treatments (physical therapy, weight loss, injections) are often undertried first.
• Spinal surgery: One of the highest rates of second-opinion reversal. Many spine surgeries are elective and based on subjective symptoms. Conservative management is often appropriate and sometimes preferred.
• Hysterectomy: Many conditions that lead to hysterectomy recommendations (fibroids, endometriosis, abnormal uterine bleeding) have non-surgical alternatives. Second opinions commonly identify these.
• Cardiac procedures (stenting, bypass): Some plans require second opinions before elective cardiac procedures. The COURAGE trial and ISCHEMIA trial showed medication management is comparable to stenting for many stable coronary artery disease patients.
• Cancer surgery: Treatment protocols differ across institutions. Academic centers often offer less invasive approaches or organ-sparing techniques not available in community settings.

BillKarma data: 30% of patients who get a surgical second opinion avoid surgery entirely, saving an average of $18,000 in procedure costs, lost wages, and recovery expenses.

7. What to do when opinions differ

A difference of opinion between two specialists does not mean one is wrong — it reflects the genuine clinical uncertainty that exists in medicine. When opinions diverge:

1. Understand the nature of the difference. Is it a difference in diagnosis (one says cancer, one says benign) or a difference in treatment recommendation (surgery vs. watchful waiting)? These require different responses.
2. Ask each physician to explain the basis for their recommendation. Request citations or guidelines if relevant. Ask: "What evidence supports this approach?"
3. Consider a third opinion. For cancer diagnoses, rare conditions, or major surgery, a third specialist opinion from a different institution is reasonable and may be covered.
4. Request a multidisciplinary team (MDT) conference. At academic and cancer centers, complex cases are often presented to a tumor board or specialty conference where multiple subspecialists review the case together. Ask if this is available.
5. Choose based on your values and risk tolerance. When evidence genuinely supports multiple approaches, the right choice depends on your personal priorities — functional recovery, quality of life, risk tolerance, and life situation all matter.

8. International second opinions for rare diseases

For extremely rare conditions where US-based expertise is limited, international academic centers — particularly in Germany, the UK, France, Japan, and Israel — may have greater experience. Options include:

• Virtual consultations with European specialists: Many offer English-language remote consultations; costs are often lower than US online services ($200–$800).
• NIH Undiagnosed Diseases Program: A free program for patients with mystery illnesses who meet eligibility criteria. Referral required; highly competitive but provides access to leading NIH researchers.
• NORD (National Organization for Rare Disorders): Maintains a database of rare disease centers of excellence and specialist referrals. Free to access at rarediseases.org.
• Global Genes and similar patient advocacy groups: Disease-specific organizations often maintain lists of the leading international specialists in their condition.

Frequently asked questions

Sources

• Mayo Clinic Proceedings: Referred Outpatient Second Opinion Examination — 21% Changed Diagnosis Study
• CMS Medicare: Coverage of Second Surgical Opinions
• NCI: Find an NCI-Designated Cancer Center
• NORD: Rare Disease Specialist Directory
• NIH: Undiagnosed Diseases Program
• HHS HIPAA: Your Right to Access Medical Records for Second Opinions
• KFF: Patient Survey — Second Opinions and Medical Decision-Making