Even if the member sticks with the doctor, an element of dissatisfaction and distrust will have been introduced into the doctor-patient relationship. The doctor will feel guilty at being unable to meet all of her patient's needs. The patient will wonder if the doctor really has her best interests at heart. Take the time to explain to her patient that the services she wants are not covered by her insurance contract and that the physician does not have the ability to force the HMO to pay. Offer to help the patient find a low cost way to obtain the services she needs.
Some communities have mental health agencies that can supply psychiatric services at a reduced cost.
Some charities give free care to disabled children. Veterans may be able to use their benefits. Also, there may be a medical review board to which the patient can appeal the HMO's decision. She can also turn to the courts. Without the surgery he will die.