Seeking 2nd opinion away from Kaiser Permanente. ?

I have Kaiser Permanente insurance,  recently I went in for my yearly mammogram. They called me back for a 2nd mammogram and ultrasound. Because they were suspicious of there being something cancerous.

They ended up not doing the 2nd mammogram and just did the ultrasound. And telling me all was well.

At the end they said in their findings: "Probably benign findings." Not very reassuring to say the least! And they sent me on my way. I would like to seek a SECOND OPINION  but outside of Kaiser Permanente, is that something that they should cover and allow me to have done?  And if someone out there knows how I could go about getting Kaiser Permanente to approve a 2nd opinion from an independent doctor not associated with Kaiser Permanente. Please let me know!Any information will be appreciated!

5 Answers

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  • car253
    Lv 7
    1 month ago

     wow!  you got some really great answers here.   you might want to repost your question again under the health category.    

  • 1 month ago

    You don't want a second opinion on what the mammogram and ultrasound indicate.  You want a biopsy.

  • Anonymous
    1 month ago

    You have the right to a second opinion.

    As far as coverage goes, it depends on whether you're on a Kaiser HMO or PPO plan.  

    HMO plan - they aren't going to pay for you to go out of network.  You CAN go out of network, but at your own expense.

    PPO plan - you have the right to choose a provider out of network.  The percentage you pay (coinsurance) is usually higher if you go out of network.    

    Why are you so against having another Kaiser radiologist review the imaging?    Many of these providers work at multiple facilities anyways - ESPECIALLY radiologists.   They could be at home in their living room reviewing images from three different hospitals. 

  • 1 month ago

    It is very unlikely that Kaiser will cover any non-emergency treatment not done by a Kaiser doctor in a Kaiser facility.  Kaiser isn't like Aetna or United Health or other insurance. You can review the specific of your plan coverage via your Kaiser portal or by calling them.  

    You can also feel free to call your ob/gyn and ask for them to discuss the findings with you in more detail.  Often when a patient has a "suspicious finding," the recommendation is to do another scan in about 3 months and or do a biopsy.  You should feel free to ask about that too.

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  • 1 month ago

    Unless your plan allows out of network treatment, it is not something that Kaiser will approve.  This is what you signed up for when you elected Kaiser for your coverage.

    Call your Gyno and discuss your concerns. 

    But a quick google search shows that ultrasounds are more accurate in diagnosing breast cancer, than mammograms.The person who mentioned about Kaiser & a PPO/HMO doesn't understand what Kaiser is.  Kaiser is a managed care program.  Treatment is provided by their employees, not independent doctors. 

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