In the past, physicians were allowed to make treatment recommendations based on their medical training, their evaluation of each particular patient's needs, and their firsthand knowledge of available medical facilities. Under HMO's, physicians are forced to make recommendations based on HMO guidelines. HMO's, though, are profit-driven organizations, thus all guidelines and decisions are based on the bottom line, not necessarily on what's best for a particular patient. if you think that decision was made other than for the bottom line by insurance companies , your the dope.