Second medical opinion: is it a legal right in Peru?

Yes, and it has its own name

Many people think asking for another opinion is rude, or something the doctor must approve. Peruvian law says otherwise. The General Health Law (Ley 26842), as amended by Ley 29414, sets out this right in article 15, section 15.1, letter d):

“d) A solicitar la opinión de otro médico, distinto a los que la institución ofrece, en cualquier momento o etapa de su atención o tratamiento, sin que afecte el presupuesto de la institución, bajo responsabilidad del usuario y con conocimiento de su médico tratante.”

(You may ask for the opinion of another doctor, other than those the institution offers, at any time or stage of your care, without cost to the institution, at your own responsibility and with your treating doctor’s knowledge.)

The regulation of Ley 29414 (D.S. 027-2015-SA) gives it a whole article, article 9, titled “Derecho a una segunda opinión médica”.

What the regulation says

Article 9 of D.S. 027-2015-SA reads:

“Toda persona, bajo su responsabilidad y según su cobertura contratada con la IAFAS o con cargo a sus propios recursos, tiene derecho a solicitar la opinión de otro médico, distinto a los que la IPRESS ofrece, en cualquier momento o etapa de su atención o tratamiento, debiendo ponerlo en conocimiento de su médico tratante quien dejará constancia de la solicitud en la historia clínica del paciente. El médico consultor tiene acceso a la historia clínica, sin poder modificarla, debiendo exhibir para ello la autorización firmada por el paciente.”

(Everyone, at their own responsibility and according to their insurance coverage or at their own expense, may ask for another doctor’s opinion at any stage of care. They must tell their treating doctor, who records the request in the medical file. The consulting doctor may access the file, without changing it, by showing an authorization signed by the patient.)

In the regulation, IPRESS is the facility treating you and IAFAS is the body that manages your coverage, such as your insurer. What this means for you:

• An outside doctor. The right covers a doctor “distinto a los que la IPRESS ofrece” (other than those the facility offers). You are not limited to another doctor at the same clinic.
• Any time. Before surgery, halfway through treatment, or afterwards.
• Notice, not permission. You tell your treating doctor, who records it. The rule gives them no power to refuse.
• The facility does not pay. The cost falls on your insurance plan, if it covers it, or on you.
• The second doctor can see your file. With your signed authorization, they can read your historia clínica but not change it.

Who pays

This is where people get confused. A second opinion is not free by law. Under article 9, it goes “según su cobertura contratada con la IAFAS o con cargo a sus propios recursos” (according to your contracted coverage or at your own expense). If your insurer covers it, the insurer pays on your plan’s terms. If not, you pay.

We did not review EsSalud, SIS or EPS internal rules on this. Ask your insurer before you go.

Getting your records to the other doctor

There are two routes. The first is in article 9 itself: the consulting doctor accesses your file by showing your signed authorization. The second is to request a full copy yourself. Article 25 of the regulation says:

“Toda persona usuaria de los servicios de salud o su representante tiene derecho a solicitar copia completa de su historia clínica, la cual debe ser entregada en un plazo no mayor de cinco (5) días hábiles de recibida la solicitud. El solicitante asume los costos de reproducción que supone el pedido.”

(You or your representative may request a full copy of your medical record, which must be handed over within five business days of the request. You pay the copying costs.)

The difference between a full record copy and the free epicrisis (discharge summary) is explained in free epicrisis vs. paid medical record copy.

A second opinion is not the same as switching doctors

These are two different rights. With a second opinion, you keep your doctor and consult another. If you want to change your treating doctor or facility, a different rule applies. Article 15.1.b of the General Health Law says:

“b) A elegir libremente al médico o el establecimiento de salud, según disponibilidad y estructura de éste, con excepción de los servicios de emergencia.”

(You may freely choose your doctor or health facility, subject to its availability and structure, except for emergency services.)

Article 7 of the regulation narrows this according to your insurer:

“Toda persona en el ejercicio del derecho a su bienestar en salud puede elegir libremente al médico o a la IPRESS que le brinde la atención, según los lineamientos de gestión de las IAFAS. Quedan exceptuados los casos de emergencia. […] Para el ejercicio de este derecho, la IAFAS debe informar por medios idóneos, a sus asegurados las condiciones del plan de salud, incluyendo de ser el caso, la utilización del modelo de adscripción para su atención en una red prestacional, en cuyo caso la elección a la que se refiere el presente artículo deberá entenderse sólo respecto al médico tratante.”

(You may choose your doctor or facility within your insurer’s management rules, except in emergencies. The insurer must tell you your plan’s terms; if the plan assigns you to a care network, the choice applies only to the treating doctor.)

So you can choose, within what your insurance allows. If your plan assigns you to a network, you choose the doctor, not the facility. In an emergency, this right to choose does not apply.

If you meet obstacles

If the clinic refuses to record your request, or to let the consulting doctor see your file with your authorization, complain in the facility’s Libro de Reclamaciones en Salud. If that does not resolve it, you can go to SUSALUD. The process is in patient complaints to SUSALUD. What your doctor must explain about your diagnosis and options is in informed consent and medical records.

What this page does not cover

We did not review how EsSalud, SIS, EPS plans or private insurers cover or process a second opinion; that depends on each plan. We do not cover the special mental health rules on hospitalization, or medical boards (juntas médicas) that facilities convene themselves. We also did not review SUSALUD decisions or court rulings on this right.