Hi Peggy: This is the way it is with managed care. I don't have an HMO but have what is called Point of Service. I can go out of network (needs no referral) but they don't pay as much, so naturally it's good to get a referral. I've had the same insurance company since 1977 and in July 1997 they started to require a primary care physician and referrals to specialists. I hadn't seen my pcp in 4 years so I called them up and they told me they didn't even consider me a patient any more and I had to reestablish myself! Then I asked if I would still be allowed to see my gyn that I have seen for TWENTY years and they said "maybe", it would depend on what the doctor thought. And I had to ask each and every time. Well, I didn't like this at all! I decided it was best to be cooperative but firm. Establish a good relationship with the pcp and I think he will be more likely to make referrals and if he seems unreasonable, then change pcps. My pcp gave me a referral to my gyn without any problems. I didn't really ask, I just said nicely, Oh, I'll need a referral for my annual gyn exam. I even needed a new doctor because my old one retired because of illness. Some states have a law that says an insurance company can not deny access to an ob-gyn. I'm waiting for maine to pass this law! As far as your adhesions and the problems they have caused, would you believe that some people have all of this with no symptoms? I've had my adhesions (the ones I had at the last lap, I'm hoping they're not there again) for at least 12 years and maybe as long as 20 and they didn't give me any problems at all until 2 years ago.(this is one reason why I question if my current problems are really adhesion problems) I had a lot of what you described. The left colon was adhered to the omentum which was adhered to the side wall, the sigmoid colon was pulled over to the right pelvic wall and stuck there, and folded back on itself at one point, plus stuck to the anterior abdominal wall. The colo-rectal specialist I saw said that some peoples' colons look like they are tied in knots and they have no pain from it. The surgeon said you wouldn't believe the messes we find when we go in and the patient never complained. I'm not saying that I believe adhesions don't cause pain, but it appears that in some people they do not, even those who have a lot.