Can my HMO pay for outside opinion as to hand and finger healing?

UPDATED: Oct 1, 2022

Advertiser Disclosure

It’s all about you. We want to help you make the right legal decisions.

We strive to help you make confident insurance and legal decisions. Finding trusted and reliable insurance quotes and legal advice should be easy. This doesn’t influence our content. Our opinions are our own.

UPDATED: Oct 1, 2022Fact Checked

Get Legal Help Today

Compare Quotes From Top Companies and Save

secured lock Secured with SHA-256 Encryption

Can my HMO pay for outside opinion as to hand and finger healing?

I had rotator cuff surgery about 5 months ago and my hand and fingers were adversely affected. I’ve had in-house therapy since then but is has not been successful. If I went to an outfit that specialized in orthopedic surgery, should my HMO pay for it as second opinion? I’m on Medicare and am 73 years old.

Asked on June 5, 2019 under Insurance Law, California


SJZ, Member, New York Bar / FreeAdvice Contributing Attorney

Answered 3 years ago | Contributor

HMOs generally will not and do not have to pay for out-of-network consultations or services; typically, it is a PPO plan that will do that. Your health insurance plan is a contract; the insurer only has to pay for those services which the policy states they must. Read your policy to see what they have to pay; they do not need to pay for anything not covered by the policy.

IMPORTANT NOTICE: The Answer(s) provided above are for general information only. The attorney providing the answer was not serving as the attorney for the person submitting the question or in any attorney-client relationship with such person. Laws may vary from state to state, and sometimes change. Tiny variations in the facts, or a fact not set forth in a question, often can change a legal outcome or an attorney's conclusion. Although has verified the attorney was admitted to practice law in at least one jurisdiction, he or she may not be authorized to practice law in the jurisdiction referred to in the question, nor is he or she necessarily experienced in the area of the law involved. Unlike the information in the Answer(s) above, upon which you should NOT rely, for personal advice you can rely upon we suggest you retain an attorney to represent you.

Get Legal Help Today

Find the right lawyer for your legal issue.

secured lock Secured with SHA-256 Encryption