Physicians often ask if they have any legal recourse when an independent practice association (IPA), health maintenance organization (HMO), or preferred provider organization (PPO), utilization review company, or other entity refuses to authorize referrals to them and/or otherwise casts aspersionson their professional reputation. As discussed in the attached sample letter from a physician to a plan, there are legal claims which may be available to prohibit such unfair actions. Depending on the circumstances, you may wish to send a letter to the entity you believe is treating you unfairly, similar to the attached sample letter. This document touches upon the legal requirements for plans to publish lists of their contracting providers.
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Failure to Receive Plan Referrals
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