E. Patient-initiated second opinions

Patient-initiated second opinions relating to the medical need for surgery, or for major nonsurgical diagnostic and therapeutic procedures (e.g., invasive diagnostic techniques such as cardiac catheterization and gastroscopy) are covered. In the event that the recommendation of the first and second physician differ, a third opinion is also covered. Second and third opinions are covered even though the surgery or other procedure, if performed, is determined not covered.

Payment (based on the reasonable charge ordinarily allowed for consultations and related services), may be made for the history and examination of the patient, and for covered diagnostic services required to properly evaluate patient need for a procedure and to render a professional opinion.