The dispute is over who will provide it. The MCO's policy is to provide follow-up by primary care providers, not the specialist in these situations. The authorization letter points out that the gatekeeper is just as qualified as you are to do follow-up. You strongly disagree, and want to respond in kind. The patient is anxious and upset about this turn of events and wants to pay you directly to do the follow-up examinations.
Recommendations Continue to provide appropriate care to the patient.
Document your disagreement in a persuasive letter to the MCO requesting reconsideration. Establish communication with the referring physician through channels protected by peer review laws if possible. Ask the MCO medical director to arbitrate this dispute, and provide clinical data to support your position. Urge the MCO's medical director to survey other primary care physicians. If not, you may have a stronger chance for compromise.