If an insured disregards a provision requiring a second surgical opinion, what may happen?

When an insured disregards a provision that requires a second surgical opinion, it can lead to reduced benefit reimbursement. Insurance policies often include certain provisions to ensure that treatment options are evaluated properly and to avoid unnecessary procedures. By failing to comply with the requirement for a second opinion, the insured might not receive the full benefits under their policy. This stipulation is in place to manage costs and ensure that the insured is making informed decisions about their healthcare, which can ultimately impact the benefits allowable under the policy.

In this context, while policy cancellation or denial of all claims could be severe consequences, they are typically not the immediate result of not seeking a second opinion. The insurance company usually opts for reduced reimbursement as a more common approach to enforce compliance with such provisions, as this encourages insured individuals to follow the necessary steps while still providing some level of coverage. Understanding these provisions can be crucial for policyholders to maximize their benefits and maintain compliance with their insurance contracts.