"Second-opinion services allow employers to take a softer approach than enforcing strict rules requiring workers to get permission before seeking costly treatments. Most companies that offer services ... make them voluntary, and though there may be incentives to get a medical decision reviewed, workers can usually skip the second opinion or ignore it if they disagree. That makes the services seem less coercive than restrictive HMO rules. It also means companies sometimes struggle to get workers to use them."

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