You will need to gather medical records from your first diagnosis. With today's electronic health record systems, much of the data that is required should be available to you in electronic, or if not analog (paper) copies. Your medical images (x-rays, CT scans, ultrasounds, etc.) and history (pathology reports, lab and bloodwork results, etc.) should be available electronically or at least on CDs or DVDs. Gather whatever information about your condition that you can so that you have it available once you find that expert for your second opinion. That should include at least pathology reports, test results and scans, as well as the text of the original physician's opinion.

Today, more and more payers are covering all or part of the cost of a second opinion. Some may suggest or require second opinions prior to surgery or other costly or invasive treatments, such as the Centers for Medicare and Medicaid (CMS). Insurance companies do not want to pay for treatments that are inappropriate, causing further issues or delaying necessary treatment. Medicare Part B pays 80% of the cost of obtaining a second opinion. If your second opinion differs from the first, Medicare will pay a similar percentage of a third opinion. Other payers, such as Cigna, Aetna, and United Healthcare are also reimbursing for second opinions in certain circumstances.

If your insurance company won't cover your second opinion, some foundation and non-profits will help. Foundations and patient advocacy groups, like Target Cancer and the Mike Shane Memorial Fund, will help guide patients to receiving a second opinion. The Mike Shane Fund helps to pay for second opinions for patients diagnosed with cholangiocarcinoma.

When you're confronted with a critical medical issue, ideally you will want to see the most experienced physician in that field, who may not be located nearby. Thanks to the rising adoption of telehealth, many centers of excellence have already adopted online second opinion programs, like Memorial Sloan Kettering and other top hospitals, providing widespread access to their highly specialized physician teams. Here are a few places to start when looking for and expert:

• Ask your original physician for a recommendation.
  Don't be afraid to ask your physician for a recommendation. Experts often know other experts in their field and are not offended when asked. Many physicians will seek advice from peers on their own.
• Reach out to family, friends and others in your network
  Ask friends and family for help, or reach out to your network. Go online and research the specialty you're looking for. Look for 'Centers of Excellence,' such as NIH NCI-designated cancer centers, leading cutting edge research initiatives.
  
• Reach out to Foundations
  Seek helps from established foundations and non-profit organizations that have been dealing with your particular illness for years. They can often connect you with support groups or members who can provide recommendations.

Find an online option to initiate an opinion. Traveling when dealing with an illness is not always feasible. You may be uncomfortable with the idea of boarding a plane right now or simply want to explore a second opinion without investing in travel/accommodations. In this case, a remote second opinion can provide guidance while you stay in the comfort of your home. If you eventually choose to travel to the institute in-person, collecting and organizing your records in advance will save you time later. If you can't find an institute's online second opinion submission form, ask the institute if this is something they offer. Some institutes do not yet have a formalized program and are still handling these over the phone.

Locating, uploading, and sharing medical records can feel overwhelming for patients. That is why in 2020 Purview launched a DICOM study uploader, helping patients to send single DICOM images to their doctors, available to patients free of charge.

Defining your goals and preparing a list of questions ahead of time will help you to get the most out of your second opinion. If you're not sure what to ask, ask the care team what questions they frequently see arise surrounding your illness. If you are navigating an especially difficult decision, especially on behalf of someone else, consider seeking counsel from a clinical ethicist, like the team at UzObi. You may want to ask about alternative, less invasive or more aggressive treatment options, depending on your circumstance and goals. You can ask about cutting edge treatments, or available clinical trials. Asking for guidance to additional resources can help point you in the right direction for educational content about your illness. The institute may be able to guide and connect you to patient groups, where you may opt to share your situation with patients and families who have already navigated similar circumstances, providing both emotional support and guidance.

Connecting your local physician to the specialty care team can help to coordinate continuing care if you plan to travel for a procedure. You may also want to seek their opinion on the information provided by the second opinion physician, spurring deeper conversations or new ideas. Physicians often consult one another, so don't be afraid to connect your physicians to find clarity and navigate next steps. If you are dealing with an especially complex or rare situation, you may also want to ask for a multidisciplinary review, also referred to as a 'tumor board' in cancer cases. More heads are better than one.

Fully participate in your treatment plan, continue learning, and advocate for yourself. Knowledge is power. Asking the right questions and seeking the best expertise can ensure you select the treatment plan that is most appropriate for you.