A few years ago, the Illinois Workers’ Compensation Act was changed in many ways. One of the most meaninful ways was that your employer could choose one of your treating doctors for you.
Under Illinois law, you are allowed to have two sets of medical opinions on your case. So if you go to your family doctor who then sends you to an orthopedic doctor who then sends you to physical therapy, that is considered your first opinion. Bottom line is that if you doctor refers to another, they are all connected.
After the new laws went in to effect, employers were allowed to dictate who your other choice was if they followed a strict set of rules. Fortunately, most of them have not done so. As a result, most employees can get a second medical opinion simply by going to whoever they want to.
You have to be very careful though because if you go outside of two medical opinions then you have to pay the bills for the third opinion.
A recent caller to my office actually did have an employer that chose her first treating doctor for her. When that didn’t go well, she exercised her right to see her own doctor and actually picked someone who is really good, a reputable neurosurgeon in Chicago.
That neurosurgeon wants to do a neck fusion surgery and the caller to my office is understandably hesitant for that to happen. So she wants to seek what in her mind would be a third opinion as she saw a neurosurgeon that her employer chose and one that was referred to her by her family doctor. The insurance company told her that if she sees this doctor she’ll have to pay for it. So she came to me to see if there is any way to solve her problem.
The answer is yes and the way to do it isn’t that hard. She simply needs to go back to her family doctor or the neurosurgeon (or anyone else she’s already seen that is within that chain of referrals) and ask for a referral to someone for a second opinion as to whether or not surgery is appropriate.
As long as you get a referral you are good to go.
It sounds like a simple solution to a complex problem and it is. But it’s also only complex because the insurance company made it that way in order to save money. If they cared about her health they could have told her what I told her, but the reality is that they simply just care about the bottom line.