Medicine: Doctors v. Paper

Health insurance, a boon to no million people in the U.S., is regarded by more and more doctors as a paper-spewing ogre. Reason: the torrent of technical information requested by insurance forms is cutting into doctors’ valuable time for treating patients, leading directly to higher costs for medical care.

With even minor treatment requiring detailed reports, many busy doctors find they can no longer get along with just a receptionist or nurse, are hiring a new kind of medical officeworker—the “insurance secretary.” The expense is passed on to the patient (some doctors now charge a special $3 fee for form-filling).

Too Unrealistic. When physicians cannot afford extra help, nurses, technicians, receptionists and doctors’ wives are pressed into service to roll back the paper tide. The physician himself must read all the reports and sign them, must give technical information that only he can supply (some insurance companies even require reports in the doctor’s own handwriting). Says an Atlanta surgeon: “I could spend a whole day right now, just dictating answers to this stack of forms here on my desk. But if I did that, how am I going to care for the people over at the hospital waiting for me to operate?”

Any reputable doctor keeps records on his patients, regardless of insurance requirements, and most physicians will agree with a New Jersey insurance executive who says: “We have to make a diagnosis, too, when we determine payment. We’ve got to know something about the case.” But doctors complain that insurance forms are not realistic, are more detailed than necessary and too diverse. Most frequent complaint: basic information about a patient’s birthplace, business, earlier illnesses, etc. must be provided on most follow-up forms each time he gets new treatment. One Los Angeles physician gave a patient a simple penicillin shot, had to call him back for a second visit when the form also required a general health checkup. A Denver obstetrician simply ignores one insurance-form question: Was the pregnancy an accident?

Too Different. A survey conducted by the Health Insurance Council shows that companies have far too many different ways of inquiring about diagnosis (26), present status (34) and treatment prescribed (46). Doctors have long sought simplified, standardized forms (some have even printed their own), but most insurance companies refuse to budge. Smaller companies seem particularly addicted to longer questionnaires (“The smaller the firm, the bigger the form,” is an axiom in the profession). Doctors are also annoyed by some companies which, when they are unsatisfied with physicians’ replies, corral neighbors to report on patients in an effort to avoid paying claims.

Doctors concede that insurance plans have helped provide prompt payment of bills, but many also complain that patients who receive insurance checks direct spend them for other things, leaving the doctor to wait for his fee. All doctors agree that the most urgently indicated treatment is fewer and simpler forms. Says one: “It would be the greatest headache remedy since aspirin.”