WAC 182-538-120. Enrollee request for a second medical opinion

(1) A managed care enrollee has the right to a timely referral for a second opinion upon request when: (a) The enrollee needs more information about treatment recommended by the provider or managed care organization (MCO); or (b) The enrollee believes the MCO is not authorizing medically necessary care. (2) A managed care enrollee has a right to a second opinion from a participating provider. At the MCO's discretion, a clinically appropriate nonparticipating provider who is agreed upon by the MCO and the enrollee may provide the second opinion. (3) Primary care case management (PCCM) enrollees have a right to a timely referral for a second opinion by another provider who has a core provider agreement with the agency.