Detailed Summary

Second Opinion Coverage Act of 2007 - Amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code to require a group health plan and an issuer offering group coverage to provide coverage for second opinions upon request under certain circumstances, including if: (1) the participant questions the reasonableness or necessity of recommended surgical procedures or of a diagnosis or plan of care for a condition that threatens loss or substantial impairment of life, limb, or bodily function; (2) the clinical indications are not clear or are complex or confusing, a diagnosis is in doubt due to conflicting test results, or the treating health care professional is unable to diagnose the condition; (3) the treatment plan in progress is not improving the medical condition of the participant; and (4) the participant has attempted to follow the plan of care or has consulted with the initial provider concerning serious concerns about the diagnosis or plan of care.

Applies such requirements to coverage offered in the individual market.

Status of the Legislation

Latest Major Action: 5/9/2007: Referred to House subcommittee. Status: Referred to the Subcommittee on Health, Employment, Labor, and Pensions.

Points in Favor

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Points Against

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