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Doctors are reporting that insurers are requiring PCP referrals for services such as x-rays, MRI’s and lab tests, forcing patients to use HMO rules even for out of network services.  We are receiving reports of doctors trying to get out of lease arrangements because they cannot make the rent, even on Madison Ave. Patients are telling us that co-pays and deductibles are higher and more services are not covered by employer sponsored plans. Doctors are still looking for new patients to make up the loss on per patient income.