More Surgeons Opting Out of Insurance Contracts

More physicians and surgeons are opting out of contracts with Medicare and private insurers, saying the system creates "too much hassle and not enough satisfaction," according to a General Surgery News report.


In a study published over the summer, investigators found that physician acceptance of Medicare patients declined between 2005 and 2008 and that physician acceptance of noncapitated privately insured patients declined more sharply.

Experts say general surgeons are the least likely physicians to cut ties from insurance carriers, while psychiatrics, dermatologists and primary care physicians are the most likely to seek alternatives. General surgeons are reluctant to opt out in part because general surgery is closely tied to third-party payors. In other words, many general surgery patients are Medicare beneficiaries, procedures are often done on an emergency basis and associated costs are higher than for primary care and other specialties.

A general surgeon who covers emergency care or urgent care services with a high percentage of Medicare beneficiaries may therefore find it difficult to opt out because a good percentage of his or her reimbursement comes from third-party payors. General surgeons also depend on referrals, which can drop significantly after physicians switch to a cash-pay model.

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