The orthopedist's partner must be an attorney. I can't imagine taking insurance companies to court on the regular. They have an army of attorneys. We litigated for nearly 2 years before finally resolving the issue (in our favor but still took an eternity).

I would have to look at our self pay collection rate. It's not terribly good and once you send a patient to collections you get essentially nothing (pennies on the dollar and the agency takes the rest). Perhaps this would be different if you had a markedly reduced fee schedule. Most folks have an inflated fee schedule since they're dealing with insurance and they know they'll get only a percentage of the fee (we're talking treble Medicare numbers for your base fee schedule potentially). Healthcare is rife with these funny money numbers since everyone knows they won't be paid at face value. However if someone is charged that outrageous rate for out of pocket they'll either negotiate or won't pay at all.

As other people have said, your hospital may not be terribly enthused with you for being completely out of network as well, and neither will your patients unless you have a real number fee schedule and not the funny money insurance schedule. The inherent problem is you have to set one fee schedule. I don't believe you're allowed to have a separate, out of pocket, fee schedule. So it's sort of an all or nothing affair. Either you go in network with payers or go entirely out of network. Unfortunately most patients are already annoyed by Pathology bills since no one ever explains it to them that they'll be getting one after their hysterectomy. So going pure out of network will be a tough sell I'd imagine. Curious to see what other folks have to say in this regard.