Before the managed care era, physicians never even considered discounting their fees. In fact, physicians were reluctant to accept responsibility for filing an insurance form on behalf of a patient. As the pressure to participate with discounted fee-for-services plans increased, physicians became more and more tolerant of discounted fees in an effort to preserve their practice base. Momentum carried this to such an extreme position that practices began participating in any and all HMO plans that presented them with an application.