405 IAC 14-6-10 Second opinions

Sec. 10. (a) Under federal requirements at 42 CFR 438.206(b)(3), an MCO shall comply with any member request for a second opinion from a qualified professional. (b) If the MCO's contracted provider network does not include a provider qualified to give a second opinion as requested by a member, the MCO shall arrange for the member to obtain a second opinion from a provider outside the MCO's network, at no cost to the member.