WAC 182-538-0120 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:

   1. The enrollee needs more information about treatment recommended by the provider or managed care organization (MCO); or

   2. The enrollee believes the MCO is not authorizing medically necessary care.

2. A managed care enrollee has a right to a second opinion from 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 department.