The War on Out of Network Health Care

The Undeniable Reality

The Hidden Crisis in Surgical Compensation: Are You Losing What You’ve Earned?

How surgeons are unknowingly giving away millions—and how to take back what’s rightfully yours.

How Insurance Companies Profit While Surgeons Lose Millions—and What You Can Do About It”

As a plastic and reconstructive surgeon, my mission is to empower doctors and their practices with innovative, practical solutions to reimagine the business of medicine. My goal is to help physicians regain their autonomy, rediscover their purpose, and achieve the kind of revenue they once believed was possible.

This page is dedicated to exposing the challenges surrounding medical revenue recovery and providing actionable strategies to overcome them.

The Facts:

Every year, $500 billion in compensation for emergency out-of-network surgeries goes unpaid to surgeons. Shockingly, only 7% of these claims are actively pursued, despite the existence of over 1,300 health insurance companies in the U.S.

• Private practices typically have 5-10 contracts with insurers.
• Group practices average 15-20 contracts.
• Hospitals and private equity companies might handle up to 30 contracts.
• Out-of-network cases account for 10-20% of most practices’ cases.

This translates into significant financial loss:

• A single-surgeon practice could be forfeiting $100,000 per year.
• Group practices lose exponentially more, depending on the number of surgeons. Even with systems in place, many only recover half of the available revenue.

The Federal IDR (Independent Dispute Resolution) process was specifically designed to help surgeons recover this revenue fairly and impartially. Yet, most practices fail to leverage it effectively.

Why? Common objections include:

• “We don’t have many out-of-network cases, so it’s not worth it.”
• “Tracking these cases is a lost cause.”
• “Our billing team handles this well already.”
• “Dealing with insurance companies is too complicated.”
• “I don’t have the time or energy to pursue these claims.”
• “I’m compensated by the hospital; this doesn’t matter to me.”
• “The potential revenue isn’t worth the effort.”
• “I’m already earning enough, so recovering additional revenue isn’t a priority.”
• “We handle claims internally and don’t need outside help.”
• “We lack the data to support this.”
• “It sounds too good to be true.”
• “We don’t have the resources to manage this.”
• “I just perform the surgeries; someone else deals with collections.”
• “I’m fully employed or fully in-network, so this doesn’t apply.”

What’s at stake?
Leaving these cases unclaimed is essentially giving insurance companies free revenue—$500 billion annually. Every dollar left unbilled or underpaid is money that could strengthen your practice, improve patient care, enhance facilities, or reduce staff stress.

By not pursuing medical revenue recovery, practices not only lose income but miss an opportunity to reclaim what is rightfully theirs. It’s time to take control and ensure fair compensation for the essential services surgeons provide.

Here’s the reality: most doctors are overwhelmed, frustrated, and disillusioned with the current system. They lack a predictable, trustworthy process to navigate it, so they often choose to ignore the situation altogether. Many tolerate the status quo, avoiding conflict with their team or organization. They rationalize that as long as the hospital provides an on-call stipend, they’re fulfilling their ethical obligations.

What they fail to see is the significant financial opportunity they’re leaving on the table—potentially $20,000 to $100,000 per case. It’s hard to fathom why anyone would willingly forfeit the money they’ve rightfully earned, especially when insurance companies are exploiting the system and counting on surgeons to stay passive.

I know this because I’ve been there—and I’ve spoken to countless others who’ve been in the same position. Yet even an additional $100,000 of ethically earned income (or more for a busy surgeon) can make a tremendous difference—not just financially, but in how you view your work and value.

Watch the video below, Aired on November 14 by the Callagy Recovery Law Firm.

If you want our help and find out how much you can potentially recover – contact me directly on my personal cell phone at 727 409 7361.

Bart Rademaker, MD