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David aren't you in a major HMO? They all operate mostly the same within the limits of the doctors who belong to the group. The point in having one is to save money and they wish to make the savings pay off for them too by not having long patient visits and to try to keep referrals to a minimum. It is up to your primary physician to make the difference for you. You can change your doctor within the HMO if you dont like him or her, but the policy is made elsewhere. Your primary physician has to push or word it just right in order to have you referred. It works the same no matter which HMO one belongs to. Group Health in Seattle was the first one in the US and it is exactly the same. I hope that your doctor will be open to the needs you have and doesn't weenie out as so many who are withing a group situation do David. Good luck.. * seattle* Audrey friend of pwp aussie John 49/42/38?