Family practitioner- recently left PPO-contracted with HMO

Reference no: EM13250804

Dr. Goode, a Family Practitioner, recently left a PPO and contracted with HMO, Inc. to receive closed access patients. Dr. Goode does not notify his patients that they need to see him prior to going to a specialist. One of his patients, Mr. Jones, goes to a cardiologist without prior approval from him. Mr. Jones, who saw the cardiologist without authorization receives a bill for the visit and all tests that were conducted at the visit. The bill comes to $1,200.00. HMO Inc.'s customer service department ignores Mr. Jones repeated calls about his bill of $1,200 that he receives from the cardiologist that he went to see without taking permission from his Family Practitioner , and now he has filed a grievance. What will happen at this point?

Reference no: EM13250804

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