For those of us who still accept insurance, we really have to admit it’s a bad business model and one we would never adopt a priori. They basically pay us less and less to see more and more patients. We have to pay very good money for claims submission software/hardware/personnel, they often take too long to pay, and they reject claims that need to be resubmitted, often for no good reason. I wonder how bad it has to get before we all refuse to accept insurance en masse- then, finally, we’ll have some leverage and things will improve. But as long as the government is trying to cover more and more people, and we all know there is not enough money in the system, we will continue to work harder and harder for less money. Not so long ago, we doctors got paid upfront in cash and the patient submitted their bills. No accounts payable for us. No fancy computers to submit claims. No personnel to monitor payments. We need to go back to that somehow. Hopefully(!) things will get so bad that we doctors will stop accepting insurance, like many of us do with Medicaid, and things will turn around