Iowa AG office, I am a licensed physician practicing in the state of Iowa, and I have uncovered a very concerning practice pattern with large healthcare institutions. Healthcare facilities in the state of Iowa are refusing to acknowledge orders from licensed physicians. I have several patients who need services only available at large centers, and we have been refused on multiple occasions.  The correspondence we receive back states that our patient must see a clinician "in their system” in order to get the necessary services. One specific example is a 20 year-old female who needs a picc line (Peripherally Inserted Central Catheter). This is an IV line for long-term access, generally done in a radiology department. I placed the order and sent a referral. We were denied, stating that the patient needs to see someone in their system. There is no medical reason for my patient to see another healthcare professional, other than increasing billables. As most of these institutions are funded by federal and state healthcare dollars, I don't understand how they can deny services and fail to acknowledge a valid medical order from a licensed physician. Can you please look into the legality of this situation?  It is paramount to a monopoly in healthcare. As an independent physician, I am not able to access critical services for my patients if this practice is allowed to continue. I have also observed this practicing other states, and will be bringing this to the attention of other attorneys general as well. Sincerely, Mollie James, DO, MPH, IFMCP