Lenny, when I ran into an Ins. issue much like yours, I did 2 things: #1, I filed a written appeal to the Ins. Co., explaining that the needed treatment was Physician prescribed and was not available in our network and that necessitated going where it was available: #2. At the same time I filed a complaint AGAINST the Ins. Co. with our State Ins. Commission to the issue. Our State commission then wrote the Ins. Co. and within a matter of 2 months, our claims were paid in full. It takes energy to fight the Ins. guys, but it is worth the effort. Good luck. Amy