In the greater Los Angeles area, Blue Cross of California, owned by WellPoint, is the 800-pound gorilla, as ophthalmologist David H. Aizuss calls it. Aizuss, who practices in a six-doctor group, says the company "doesn't negotiate—you accept its terms or you take a hike."
Some primary care doctors in the area have decided to do just that, but it's hard, he says, for surgical specialists to follow suit. "Most surgical specialists find that they have to contract with a lot of different plans."
It's also hard to jump plans, he says, unless your specialty is in short supply: "A good friend of mine is a pediatric neurologist, one of only a very few in the San Fernando Valley, which has a population of well over a million people. Because he's a scarce commodity, he's able to refuse any new contract that doesn't meet his terms, which amount to paying him his usual and customary fees. Otherwise, he doesn't bother." His own situation, Aizuss realizes, is quite different. "For ophthalmologists who may have 10 colleagues down the street, it's much more difficult to negotiate these things."