Patient Guide: Getting a Second Opinion in the USA

Getting a Second Opinion in the USA

Helpful Resources

Why Consider a U.S. Consultation?

  • Appendix cancer is very rare; few Canadian centres see many cases.
  • Some U.S. hospitals perform large numbers of CRS/HIPEC surgeries each year.
  • A second opinion can confirm your diagnosis, provide new treatment options, give access to clinical trials.

When to Ask for a Second Opinion

  • At diagnosis: to confirm pathology and treatment options.
  • Before major treatment decisions: such as surgery (including CRS/HIPEC) or systemic therapy.
  • If treatment isn't working as expected.
  • Whenever you feel unsure about your plan.

Step 1: Gather Your Records

You will be asked to upload/share your information with the Hospital/Specialist.

Required Documents:

  • Pathology reports
  • Imaging (CT scans)
  • Operative notes & bloodwork

If Known:

  • Genetic mutations (for example: KRAS, GNAS, BRAF, TP53)
  • Biomarkers that may affect treatment (HER2 status, MSI status)

If Available:

  • Molecular or genomic testing (sometimes called NGS – Next Generation Sequencing)

Helpful Tips:

  • You may ask your oncologist or surgeon's office for copies (you are entitled to these).
  • If you have registered, you may check your hospital's online portal for your records.
  • Apps such as PocketHealth can download imaging and reports so you do not have to request CDs/USBs from the hospital.

Step 2: Contact a U.S. Centre

  • Many major cancer centres have International Patient Offices.
  • You may self-refer or ask your doctor to send a referral.
  • Telehealth consultations may be available for second opinions. You will be scheduled for this discussion after the Tumour board has reviewed your case.
  • If you are a surgical candidate, an in-person visit will likely be required.

Note: Upon referral to a specialist, your case will be reviewed by a tumour board, where surgeons, oncologists, and pathologists give input together. Tumour boards don't always meet every week so this may cause a delay.

Step 3: Understand the Costs

Consultation Costs:

  • Free or waived consults: Some U.S. surgeons offer no-cost consultations (costs recovered if surgery is performed).
  • Upfront fees: Some charge USD $500–$1,000+ for a telehealth or written opinion.

Provincial Coverage:

  • Not automatic — must be applied for in advance.
  • BE AWARE: If you go without PRE-approval the provincial plan will likely not reimburse you afterward, even if the consultation was essential.

Surgery Costs:

Understand that the costs of surgery and related follow up care in the USA can be extremely expensive so it is important to discuss this ahead of time with a financial specialist.

Step 4: Provincial Health Coverage (Out-of-Country Care)

Each province has a program for Out-of-Country Prior Approval.

Application Requirements:

  • Your Canadian specialist must apply on your behalf.
  • Approval is usually only granted if:
    • The treatment is not available in Canada, or
    • It is available, but not within a medically acceptable timeframe.

Application Process:

  • Your doctor completes provincial forms and attaches medical records.
  • The provincial ministry of health reviews the request.
  • Decisions can take several weeks, but urgent cases may be expedited.

If Approved, your province may cover:

  • The consultation and medical services (billed at provincial rates).
  • Part or all of the surgery and hospital stay.
  • Not typically covered: Travel, accommodation, and some hospital "facility fees" are usually not covered — patients often pay these themselves.

Provincial Resources:

Step 5: If Denied Coverage or Too Urgent

You can proceed self-funded.

Keep all receipts — many expenses can be claimed on your Canadian tax return:

  • Consultation and treatment fees
  • Prescription drugs
  • Travel, meals, hotel stays, and parking if required to travel over certain distances and specific conditions are met
  • Travel companion costs (if medically required)

Claim through the Medical Expense Tax Credit (METC).

Key Takeaways

  • Start early: Gather records and explore both Canadian and U.S. options.
  • Ask your doctor: Their support is needed for provincial coverage applications.
  • Don't delay: If approval is slow, you can still proceed and use tax credits.
  • Keep receipts: Medical costs may be partially offset at tax time.
  • Be aware: Medical costs are extremely high in the USA

Disclaimer: This guide is for informational purposes only. It is not a substitute for medical advice, legal advice, tax advice, or professional guidance. Patients should always consult their healthcare providers, provincial health ministries, and a qualified tax professional before making decisions about treatment, insurance, or financial matters.