I have an HMO too, Harvard Pilgrim. I know in my schedule of benefits it tells you what's covered & what's not- I'm pretty sure all 2nd opinion consults are covered in full, but you have to pay the office visit co-pay. I'd call your insurer & tell them what you want to do, tell them who you want to see, & if he's in their network you should be all set. That's another good thing about
the big guys in Boston- they seem to be in EVERY insurance network! And your own GI or primary care doctor can give you a referral for a 2nd opinion consult if they have to. I did have to get a referral from my primary care doctor, come to think of it, but lucky for me he's really easygoing with the referrals. I just had to call his office & they gave me the number. Your clueless insurance customer service rep. probably figured a biopsy was like a day surgery procedure, giving you that high a co-pay figure! Talk to a supervisor if they seem unsure or anything- you wouldn't believe the hoops I jumped thru with Harvard Pilgrim just verifying that remicade was covered in full! And it is, although about
6 "member service reps" told me it wasn't. Which probably sent my stress thru the roof, causing the huge flare!