You might want a second opinion about care your provider says you need or about your diagnosis or treatment plan. For example, you may want a second opinion if you are not sure you need a prescribed treatment or surgery, or you have tried to follow a treatment plan and it has not worked.
If you want to get a second opinion, we will refer you to a qualified network provider who can give you a second opinion. For help choosing a provider, call Member Services at 1-888-839-9909 (TTY: 711).
L.A. Care will pay for a second opinion if you or your network provider asks for it and you get the second opinion from a network provider. You do not need permission from L.A. Care to get a second opinion from a network provider. However, if you need a referral, your network provider can help you get a referral for a second opinion if you need one.
If there is no provider in the L.A. Care network to give you a second opinion, L.A. Care will pay for a second opinion from an out-of-network provider. L.A. Care will tell you within 5 business days if the provider you choose for a second opinion is approved. If you have a chronic, severe or serious illness, or face an immediate and serious threat to your health, including, but not limited to, loss of life, limb, or major body part or bodily function, L.A. Care will tell you in writing within 72 hours.
If L.A. Care denies your request for a second opinion, you may file a grievance. To learn more about grievances, go to the Complaints page in this handbook.