Doctors are not required to accept health insurance plans and many choose not to work with particular insurers or government payers that offer lower reimbursements to doctors. Instead, they may move to cash-only medical practices or develop their own payment plan. A major reason for this is the denial of claims by insurance companies, which makes it harder for doctors to accept patients in their plans by lowering reimbursements. Consequently, lots of doctors are dropping plans. Physicians negotiate the price of treatment with health insurers and the health insurance company sets the rates that it will pay the doctor. Additionally, some insurance companies may include quality metrics that must be met for the doctors to receive the full reimbursement. While insurers set the rates, the physician has the final say in whether or not they agree to the terms established.