hmo

What is the name of your state? california My friend's brother was diagnosed with esophacus cancer and was opened up then closed and needs radiation treatment, and kimotherapy. because of the hmo he needs to be sent to a specialist. My friend wants to send him to Cedars Sinei in Los Angeles, To the specialist there, who is a provider of his hmo. But the Doctor refuses to refer the brother there. Can he legally do that even though the specialist at Cedars is a provider of his hmo? What can he do, there isn't alot of time to waste apparently.
Thanx for your help

You say the cancer specialist is a providor contracting to the HMO? Then you had better get a lawyer who can read their contracts to them. If what you say is true, they have no right to prohibit your brother in law from seeing the doctor he chooses within the HMO list.

[cbg]

At least in my part of the country, there are some hmo contracts that require that a referral be done to a provider within x miles. So even if a provider is within the network, if s/he is outside of that "circle" range, the PCP cannot refer to him. Is there any possibility that this is part of the contract?

What reason has the doctor given for refusing to refer to this provider? It might make a difference.