When describing to the curious the benefits of opting out of both Medicare and private insurance, Gerard J. Gianoli, MD, president of The Ear and Balance Institute in Baton Rouge, La., often recalls one particular example: During one 90-day global period about five years ago, after an eight-hour resection of a skull-based glomus tumor, post-operative ICU care and several days of inpatient care and the usual post-operative office visits, he received a total reimbursement of $500.