In the 5 + years that health insurance plans have been built around copayments to the doctor, I have wondered how long it would take for the Physician community to revolt against the health maintenance organizations and the insurance companies. I couldn’t imagine putting all that time and energy into becoming a doctor, only to have some third party tell you how much you can be paid for your services.

That revolt is happening, and looks to be starting based on medical specialty, location, and reputation.

It is typical to design healthcare coverage using a copay to limit the cost of routine care for the patient. So, with that as a plan design objective, it is likely that your pediatrician or your internist will remain in most networks.

But it is the specialists, whose skill and bedside manner are crucial in the very expensive and many times life threatening medical situations, who are fleeing the networks. They are in such demand they do not need to subscribe to a network reimbursement schedule, and frankly, why should they?

This may not be an issue in rural America, but in metropolitan areas you can expect talented specialists to run outside the network.

So where does that leave health insurance?

In that these specialist services are more critical, and will create a higher out-of-network expense, we need to rethink coverage. It is important to reevaluate deductibles and coinsurance, as well as the percentile of UCR (usual, customary and reasonable) for expense reimbursement to avoid the insured being left with a large uninsured bill in critical care.

It is sensible to recognize the trend in specialists going out-of-network, and pay particular attention in designing current and future benefits to avoid the unexpected.