Sick, and Tired of the Endless Paperwork

Sick, and Tired of the Endless Paperwork

We've been charged for seeing doctors we never met, and even for the armrests on my wife's wheelchair.
By Doug GarrNewsweek, June 21, 2004

When my wife, Meg, suffered a severe stroke that immobilized her left side, I knew we would be facing a grueling odyssey involving several hospitals, dozens of doctors and countless therapy sessions. What I wasn't prepared for was the American Way of Managed Health Care, a system that is bureaucratic and often dysfunctional. Yes, medical practitioners in the United States are generally considered among the best in the world, and my wife primarily had first-rate care, but their back-office practice—a business dominated by third-party payers—is badly run at worst and woefully confusing at best.

Meg's stroke occurred while we were vacationing in the south of France last summer. After being stabilized in the emergency room of a small hospital, she was transferred immediately to a large teaching hospital, where she received excellent treatment in a world-renowned stroke pavilion. When I received the bill for her 2-1/2-week stay at the Pasteur Hospital in Nice, I asked the deputy administrator for an itemized statement. I knew I'd need to show it to our health-insurance company—the one-page invoice for more than 20,000 euro wouldn't do. The administrator was puzzled. There were only two daily rates, he explained, one for soins intensifs—or intensive care—and another for non-acute care. There were no extra charges; the numerous ambulance transfers, MRI brain scans, X-rays and assorted tests associated with any serious injury or illness were all-inclusive. In fact, the only supplement was 10.67 euros—about $13—a day for food which, although not three-star bistro quality, was certainly a bargain, and better than anything you can eat in a U.S. hospital.

I'm not arguing that the French health-care system should be a world benchmark, but compared with what we faced when we returned home, it was a model of simplicity and efficiency. Of course, everything in American medical care is a la carte, and the invoices are so dense with codes and abbreviations, it's a wonder anyone can decipher them. I often wonder, how much does this cost the American public annually?

At one New York hospital, we received bills from doctors we'd never heard of, including one who charged for an office visit when Meg couldn't even get out of bed. The managed care provider's computer sent him a check without question. Had he not billed us for the co-payment I never would have noticed the error. Over the past few months, I spent hours clearing up these kinds of mistakes. A doctor friend who heads a department in a large hospital admitted that these kinds of complaints are all too common.

Meg's medical tab has reached nearly $300,000, which seems monumental, even given the nature of her catastrophic injury. Thankfully, we were covered for most of it. Yet $90,000 of that figure had little or nothing to do with patient care. Roughly 30 cents of each health-care dollar goes to administration, or the processing of paperwork. If that figure could be reduced by a third, even $30,000 would go a long way toward extending her rehab treatments. (Meg's 2004 benefits have run out.)

When Meg was finally discharged after spending 56 days in hospitals, we received co-payment bills for her medical equipment, including an itemized statement for every extra on her wheelchair (no, the brake extensions, foot pedals, armrest, anti-tip bars, seat and seat belt are not included). But the provider billed us two ways, one for leasing the chair and another for purchase. Even now, after numerous phone calls, I still don't know whether we own or are renting the wheelchair.

The outpatient rehab therapy sessions presented their own set of challenges. The hospital sent a number of bills—printed in alphanumeric codes—for additional thousands of dollars even though we made the proper co-payments at the time of treatment. Billing administrators barely raised an eyebrow when I told them I had spent too much time on hold and would no longer bother calling to dispute the charges. (We have since received automated early-morning phone calls asking us to contact the hospital.)

I've checked with others who have had protracted negotiations with health-care providers and insurers over complex medical treatment. They echo my frustration. Why is it incumbent on the recipient to spend countless hours rectifying the medical administration's mistakes? How much extra does this process add to the nation's annual health-care bill?

Medicare—our government-subsidized system that cares for the elderly—has a much better record in administrative costs. It spends between three and four cents of every dollar on paperwork and processing. A single-payer system is easier and cheaper to run. We've had a two-tier health-care system in the United States for a while, and only one tier works. Isn't it time for managed care to slim down and help its patients get better instead of burdening them with needlessly expensive paperwork?

Garr is a writer living in New York City.--