The concept of delivering care based on the percentage of usual and customary charges paid is unacceptable from a professional ethics standpoint, not to mention from a malpractice liability standpoint. (See "Reader asks: Pay for performance? Why not base performance on pay?")
Once a patient comes under our care, we obligate ourselves to deliver the best care that we can. Payers are motivated to constrain access to care and to pay the minimum the market will bear for care delivered.
Logically, one should not enter into a provider relationship with a payer or patient who cannot (or will not) reimburse you at a rate commensurate with your costs. If patients find their access to reasonably competent care excessively restricted, they will make adjustments in their financial decisions to correct the situation -- for example, change payers or commit more of their resources to their healthcare needs.
Dan Matthews, M.D., Austin, Texas