At any time during the course of treatment, the PBH care
manager, the member or the provider may solicit a second opinion.
Members or providers may request a second opinion by submitting
either an oral or written request to PBH. The request will
be reviewed and evaluated by a PBH licensed clinician based
on Medical Necessity, the nature of the recommended treatment
plan and the member's current symptoms.
All decisions regarding second medical opinions will be rendered
within the following time limits:
Urgent/Emergent treatment within 24 hours
All other treatment within fourteen 14 calendar days
Second medical opinions may only be rendered by providers
qualified to review and treat the medical condition in question.
Request for referrals to non-participating providers for second
medical opinions will be considered only in the event that
the services requested are not available within the contracted
network of providers
Second medical opinions requested by the member and authorized
by PBH will be deducted from the member's available benefit
plan and the member will incur the applicable copayment amount.
If a second medical opinion is requested by PBH or by the
treating provider, the member will not be required to pay
a copayment and their benefit will not be reduced.
