How many doctors reject insurance?

For many doctors, opting out of the system is the only way in which they can demonstrate their own power in the market. For others it's the way they stay independent.

Albert Fuchs and wifeInternist Albert Fuchs doesn't take insurance anymore. (His lovely bride, shown with him here, is an immunologist.)

He also wrote a guest column for the LA Times bragging about how he did it.

Slowly. He first cut off the carrier who reimbursed him the least. Then when his business stabilized he cut off another one. Then another. Until he had none, yet his practice survived.

Letter writers quickly dumped on him for his choice.

  1. One wondered about what happens to his patients when they're referred to a hospital and the doctor is "out of network."
  2. Another compared his approach to junk food.
  3. A third noted he's based in Beverly Hills -- presumably his choice would be harder to make in Pawtucket.

Fuchs is far from the only doctor doing this.

My new chiropractor lists two prices -- one for cash and one for insurance patients. Her insurance price is reasonable compared to others I've seen charged the carriers, but her cash price looks more reasonable to me.

My dentist takes a different approach. He charges full price, then hands us the insurance forms so we can pursue our own claims. Given that my lovely bride does this only once a year, it's kind of like a Christmas club.

For many doctors, opting out of the system is the only way in which they can demonstrate their own power in the market. For others it's the way they stay independent.

I've found that most doctors in large practices, or attached to hospitals, are happy to take insurance. They share back room staff. One group practice I visited recently shared a floor with a second group specifically to share this back-office work.

The point is that insurance payment processing is very expensive. It adds considerably to every bill, and the hassle is pushing doctors out of the system in droves, especially those in small practices.

I would love to know exactly how many physicians have dropped out of the system, in what specialties, where it's most prevalent, what size practices have dropped out, and what the whole impact is on the rest of the system.

That's a market research report people would pay for.