Appeals and Second Opinions

Appeals and Second Opinions

Second Opinions

As a patient, you have the right to obtain a second opinion. If our Care Management Department has declined to authorize a procedure because it is not considered medically necessary, you may get a second opinion from a contracted or non-contracted physician.

If you want a second opinion from a doctor not contracted with John Muir Health, you must contact your health plan for authorization of the consultation.

Appeals

If you disagree with a decision, we have made about your health care, you can appeal by submitting a written appeal. You have the right to appeal denials directly to your health plan. Contact customer service at (925) 952-2887, option 1, TTY/TDD users may call 711, for instructions on filing an appeal for denied services.

Note: All decisions regarding authorization of services are based on the appropriateness of care and service. John Muir Health does not compensate practitioners or other individuals conducting utilization review for denials of coverage or service. Financial incentives for individuals making utilization review decisions do not encourage denials of coverage or service.