Second opinion

What is a second opinion?

A second opinion is an independent assessment of a diagnosis or a proposed treatment by a second doctor. A typical situation is before a planned operation: your specialist recommends a procedure, and you want to know whether another specialist comes to the same conclusion or sees an alternative.

In Swiss health insurance, a second opinion is not a separate type of benefit. The Federal Health Insurance Act (KVG) does not mention the term. Basic health insurance pays for examinations and treatments that serve to diagnose or treat an illness. A second medical assessment falls exactly within this, as long as it is medically justified. It is therefore billed like any other consultation.

A second opinion should be distinguished from two similar things. First, from changing doctors: if you move your treatment entirely to another doctor, you are not getting a second opinion but changing your service provider. Second, from the review by the insurer’s medical adviser: the medical adviser assesses whether the insurer has to pay for a benefit and advises the insurer, not you.

Some health insurers also offer their own second-opinion services, often by phone or through a partner organisation. These are voluntary offers by the individual insurer or part of a supplementary insurance. Whether and how your insurer offers something like this is set out in its documents; the profiles under health insurers show the basic data for each insurer.

How it works

The procedure depends mainly on which insurance model you have in basic health insurance.

Standard model with free choice of physicians: For outpatient treatment you can choose freely among all authorised doctors who are suitable for your illness. You book the appointment for the second opinion directly. The bill goes to you or to your insurer as usual.

GP, HMO or telemedicine model: You have committed yourself to contacting your first point of contact first. In the GP model this is your GP practice, in the HMO model the group practice, and in the telemedicine model the telephone advice service. If you want a second opinion, you discuss it there and receive a referral. If you go directly to a specialist without a referral, the insurer may refuse to pay the costs. Exactly what applies in the event of a breach is set out in the conditions of your model.

Documents: So that the second specialist does not have to repeat everything, ask the first practice for copies of the findings, laboratory results, X-ray or MRI images and reports. Under the Federal Act on Data Protection (FADP) you have a right of access to your personal data.

Costs: The consultation counts towards your deductible. Once you have reached it, you pay a 10% retention fee until the annual maximum of CHF 700 is reached (children CHF 350). If additional examinations are needed for the second opinion, the same rules apply. However, the insurer does not have to pay for duplicate examinations without a medical reason, because every benefit must be effective, appropriate and cost-effective.

Legal basis

The KVG does not contain an explicit entitlement to a second opinion. Cost coverage follows from the general rules:

• Art. 25 para. 1 and 2 let. a KVG: Compulsory health insurance covers the costs of services that serve to diagnose or treat an illness, including outpatient examinations and treatments by doctors.
• Art. 32 para. 1 KVG: Every benefit must be effective, appropriate and cost-effective. A second opinion before a procedure generally meets these criteria; a mere repetition of the same examination without any new benefit does not.
• Art. 41 para. 1 KVG: For outpatient treatment, you choose freely among the authorised service providers who are suitable for your illness. The insurer reimburses according to the tariff of the chosen service provider.
• Art. 41 para. 4 KVG: If you have chosen a model with a restricted choice, you waive this free choice in agreement with your insurer. The insurer then only has to pay for services carried out or arranged by the selected service providers. The statutory benefits remain insured in any case.
• Art. 64 KVG and Art. 103 KVV: You pay the deductible and a 10% retention fee on the costs, at most CHF 700 a year for adults and CHF 350 for children.

For certain planned procedures, the “outpatient before inpatient” rule under Art. 3c KLV also applies. It does not concern the second opinion itself, but it is often the reason for asking where and how a procedure should take place.

Example: knee arthroscopy in the GP model

Laura is 45, has a CHF 1,500 deductible and is insured in the GP model. An orthopaedic surgeon recommends an arthroscopy of her knee. Laura wants a second opinion first. She discusses this with her GP, who refers her to a second orthopaedic practice.

The amounts below are assumed bill amounts to show the calculation; the actual costs depend on the tariff. The deductible and retention fee are the statutory values.

Incidentally, arthroscopy of the knee joint is on the list of procedures that are in principle carried out on an outpatient basis (Annex 1a KLV, version of 01.01.2026). That can also be a topic for the second opinion.

What this means for you

A second opinion is your right as a patient and, in basic health insurance, costs you no more than a normal consultation. These points will help you:

1. Check your model. Look at your policy to see whether you are insured in the standard model or in a model with a first point of contact. In the second case, contact your first point of contact first.
2. Bring your documents. Findings, images and reports from the first assessment avoid duplicate examinations and therefore costs.
3. Prepare questions. What alternatives are there? What happens if I wait? Outpatient or inpatient?
4. Consider the timing. Before planned procedures you have time. In emergencies: get treatment immediately.

If you often want to see specialists of your own choosing, the standard model may suit you better than a cheaper model with a first point of contact. You can see the premium difference between the models in the premium calculator. You can change your model with effect from 1 January; the dates are listed under deadlines.

Common mistakes

• Going directly to a specialist in the GP or telemedicine model. Without a referral, the insurer may refuse to pay the costs.
• Thinking a second opinion is free of charge. The deductible and retention fee apply as with any consultation.
• Going to the appointment without documents. Examinations are then repeated, and the insurer does not have to pay for this duplication in every case.
• Confusing the medical adviser with a second opinion. The medical adviser advises the insurer on whether to pay, not you on which treatment to choose.

We explain how we prepare examples and figures under How we calculate.