We just can't afford it anymore. As high labor costs and other expenses continue to rise, the four physicians have taken a pay cut each year since 1992 to make ends meet, says Dr. Litwin-Sanguinetti. Each doctor sees about 18 patients a day. This year, the practice has been hit with an overall 25 percent decrease in reimbursement rates. While there is disagreement about whether enough physicians are going cold turkey with managed care to call it a trend, some industry experts say dissatisfaction over reimbursement rates will help shake up in the managed care industry.
Physicians have the right to terminate the contract when rates are reduced.
But Dr. Pulskamp says it's especially burdensome for patients to change physicians during a pregnancy. The physicians aren't worried about losing patient volume. The cancellations barely hurt patient volume, the doctors say. When you have a baby you want to be comfortable, and these women provide the best service possible. Ms. Russell's insurance allows her to visit a physician or hospital outside its provider network, but pays only 50 percent.