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hi Pat
yes hmo's have a utilization review and a medical director on staff. you must
stay in network to be treated. most physicians on the network and specialists
also are credentialed and are only accepted to the hmo network after total
scrutinization.
and yes they the have right to request medical records. when you enroll you
are giving them the permission to do so. there are many diseases that have
to be managed to best of any doctors knowledge. the hmo will refer to
non-par ONLY if their is not a qualified specialist on the network. It must
be very frustrating for you to understand managed care but it is the way
medicine is going to be practiced from now on. I believe there are many
qualified primary care physicians and sprecialists in his country that are
signed with various HMO'S.
ask lots of questions, ask for second opinions they will do this and I'm sure
that your son 's medical care will be taken care of to the best.
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