I experienced this conundrum first hand when a family member required a routine diagnostic test. We followed all the rules. Our doctor was in our health plan. The hospital where the test was administered was in the network. But then we received a bill out of the blue from the anesthesiologist–who, it turns out, accepts NO insurance plan.

We complained about how unfair this was. How are we to know whether assisting providers who are brought into a procedure without our knowledge or consent are not in our plan? But we received no sympathy from the hospital, which noted the point was moot, since NONE of their anesthesiologists accept insurance–apparently because these specialists are fed up with how little carriers pay them.

Our doctor was kind enough to intervene and help us negotiate a slightly lower fee, but we still had to cough up a hefty chunk of cash to cover the difference between what the insurer would pay and what the anesthesiologist wanted. How crazy is that? What “choice” did we have in this dark corner of the “free” market?

In a way, I can't blame the doctors. An entire white collar workforce has been created just to submit claims for doctors and fight with insurers to get them paid. It must be very tempting indeed if you have a skill that is unique to simply opt out and not be hassled anymore.

Of course, this means if an unfortunate sick person cannot afford their doctor's skilled services, they are out of luck. Or even if they can afford the bill, they must still shell out big bucks to keep their preferred provider on their team–even if they have insurance!

My gut feeling, however, is that if a doctor is licensed by the state to care for its citizens, they cannot just treat people wealthy enough to afford to see them. If a patient has insurance, they should accept what the insurer pays and leave it at that.

At the very least, any provider working in a particular venue–even if they are an independent contractor–should be required to accept whatever insurance the facility takes.

(What about those without health insurance? That's a good question. Any answers, folks?)

If you want to level the playing field for the doctors a bit, you could set national benchmarks for certain procedures, and require all insurers to pay that minimum. That's an element of national health insurance I could live with.

If enough doctors stop accepting insurance, could that be the tipping point that prompts voters to demand broader healthcare reforms from elected officials? Perhaps, but until then, it looks like it's every man for himself.