I was diagnosed with glaucoma when I was 72 and prescribed a medication and told to start taking a prescription drug and follow up regularly. Less than 12 months later I went to see a different eye doctor in my city and they added on to the prescription. Medicare said that the 2nd visit 10 months later was not a second opinion and would be covered (2nd opinions are in fact covered anyway). But the added new prescription is concerning to me because it has undesirable side effects. I'd like to go to another doctor to get his opinion about taking the new prescription and probably follow his treatment course. A second opinion is covered and third opinion is only covered if the first two opinions are different. Medicare has spent hours on the phone with me telling me that to determine whether my third visit will be a third opinion they will have a non-government contractor who works for the Federal program called Medicare examine both the claim submitted by the medical practice. The contractor would consider the diagnosis code and the textual notes of the doctor. Medicare's individual independent contractor's judgement would then determine whether the first two visits were opinions or treatments and thus whether my third visit was covered as a continuation of treatment or a third opinion which may or may not be covered depending on whether visit 1 and visit 2 were differing opinions or opinions at all. If disagreed with the findings of the independent Medicare contractor who might be 19 years old and not have graduated from high school, then I could submit and appeal which would then get sent to a QIO, which is a Quality Insurance Officer (or something like that) who is another independent contractor hired by Medicare. This person could also be 18 years old and a high school dropout. Then that potentially uneducated person very likely doesn't know the mountains of Medicare law that would take a trained Medicare lawyer decades to absorb and may hardly pay attention to the dispute anyway. If you don't like the QIO's judgement you have the option of fighting the case all the way up to through the court system.
I have no desire to fight something all the way through the court system. I'd like to determine in advance whether going to see a third doctor would be covered. I think that's reasonable. Don't you? Can someone voice an opinion about whether he or she thinks seeing a third doctor would be covered, or how I could go about determining that?