Question

My husband had acl reconstruction on his knee. Our Pmd referred him to a Sports Med. Spec. who performed the surg. @ another hosp. We have one orthopod at the hospital I work at as the other two left within the last 2 years. Our hosp. owned ins. plan paid @ 50% stating it could have been done at our hosp. The remaining orth rarely does acl reconstruction having done 2-3 in the last 2 yrs.   We appealed which was denied even though our Pmd sent a letter explaining the referral. We will appeal a third and final time. Can we be forced to accept treatment from the only available physician and be penalized because we sought treatment from a physician who routinely performs this surgery and is an in-network physician at another institution. Do we have any recourse or supportive options