Doctors Refusing to do the Paper Work
 

I was in to see one of my doctors today. We talked about a growing trend in the medical community. It seems doctors are growingly reluctant to do the paperwork for things like Disability Insurance Claims, Insurance Claims, Medicare, SSI, etc. The reason he gave is that the amount of paperwork over the years has simply multiplied for doctors. So, they are still providing the care but not helping patients, who are trying to pay for the care or help them by filling out the paper so their disability claims requirements are met, so they can collect from the claims with their insurance companies. He said that this is a growing trend, and it is going to continue to get tougher for patients to convince their doctors to do the paperwork for them. In this doctors opinion, some doctors feel that they have little choice. They either holistically stop filling out the papers for everyone, or they must leave their practice, because it is simply getting to be way too much for them to handle.

Has anyone else heard or experienced any of this before? I found it enlightening.

One doctor I saw had a sign in his office saying he charged $35 to fill out disability paperwork.

I'm in the medical field and have to fill out disability, FMLA, etc. all the time. It is very time consuming and I usually find myself having to stay after hours to do it or come in early to get it done uninterrupted. The problem is there is no way for a physician to bill for paperwork. The forms can be quite time consuming. I don't have an issue with a doctor charging to fill out the form. I do think it is a problem if they refuse all together to fill it out.

I know we're not to get into politics in here but that' the answer. The Saul Alinsky way of over whelming the system until it breaks. Forcing doctors out by making them do a lot of unwanted tiresome paperwork and I shutter to think what's going to replace them. In my opinion...

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My doctor did not charge me for filling out the handicap parking request, but I would have gladly paid him a small fee for this service.

I had the same trouble----I have SFN
 

The one doctor that I know of who is refusing to do the paperwork says that it is not her job to do so. That has to hurt their reputation among current & prospective patients. I'd think that those who do this are bound to lose many patients, because insurance lays at the very heart of the medical vocation.

Hey there BioBased :)
 

Interesting topic.

My PCP has been fine with filling out any paperwork. He also has the benefit of a large support staff to help with all tasks. I appreciate all he and his staff do for me.

I think these types of added tasks are more difficult for smaller practices, as the doctors are usually already pressed to the max. I don't mean to overly generalize, yet just an observation from different types of practice settings/styles.

Years ago, my disability insurer was trying to force me to take a low-ball settlement. A part of their game was to start asking for paperwork every 2 months, instead of annually. I typed a letter to my PCP, telling him of their tactics, apologizing for their harassment of him, and told him to bill them for his time. (If he billed them and they did not pay, at least theoretically, their bill would go to collections.)

I had copied the letter to the insurer when the paperwork was completed and returned. The insurer then placed a notice on all of their paperwork, stating they were not responsible for payment for the completion of any paperwork.

The insurer had also stopped playing that game, immediately thereafter.;)

I do believe the paperwork issue is becoming a bigger issue. Doctors I see have to steal time out of their schedule to finish appointments, as it is. I know my PCP goes in, often, on his day off, to finish up paperwork, etc.

I'd hope a doctor would bill for time to fill out paperwork before simply refusing to fill out paperwork. I know billing may create a hardship as well, yet at least the paperwork gets done and disability claims are kept up-to-date, etc.

I am looking forward to reading more posts on this topic.

Warmly,
DejaVu

I wonder if you have a long term relationship with same MD , they might be more inclined to fill out forms?
I would think some of it could be done by office staff, and MD would verify & add final details?

Hi Spike, all my doctor's (now) charge an extra fee of anywhere from $15-$50 to fill this paperwork out as it can be time intensive for them. The patient pays for this out of pocket, it's not something insurance will pay for. :)Hope that helps.

Great points, Jo*Mar.
I've had my PCP for 24 years. He always says he will do anything he can to help me. At the same time, his practice is closed to new patients, which can limit demands upon his time.

I've seen some paperwork in other offices, for new patients, asking if they were planning on filing a disability or WC claim? I have no idea as to why that question was asked, as I have long-term relationships at those offices; thus, I have not been a new patient with them since they'd started to ask this question.

As this doctor said, ABSOLUTELY NOT. Filling out forms is NOT my job.

Unfortunately, that type of a response leaves his patients subject to an examination and an opinion rendered by someone hired by an insurance company. Many people feel the doctors hired by insurance companies will not be fair. These doctors are often viewed as "hired guns" by the individuals insured and filing a claim.

The doctor you quote, Spike, is clearly stating he will not accommodate any patient with paperwork needs. I only hope he announces his policy upfront, before anyone needs paperwork completed.

I have never heard a doctor say such a thing. I am sure there are some doctors saying this. All of my specialists say they will do anything they can to help, fortunately.

A doctor that would say that to me would not be my doctor for very long.

I know in Canada, Doctors are allowed to charge the company that wants the paperwork up to a set dollar amount, after that the remains get pushed onto the client. WCB would ask you to get your doctor to sign forms, he/she'd fill them out and charge WCB. Same for the Disability, it would be charged to either Provincial or Federal (depending on which paperwork you are doing). Which seems to work. Walk in clinics do NOT offer this paperwork scheme. They can do sick notes, and WCB claims. That's it, they won't do Disability because they just don't have that repitorie with you. It works well out here, but there is still that HUGE crunch, as we are always critically short on doctors, putting more pressure for them to make appointments as quick as possible.

WC is a nightmare for docs in CA (as well as many others). Paperwork is generated in mass volumes to discourage docs and patients from requesting meds and/or procedures. My last doc decided to stop treating WC patients because it was costing him too much overhead. My current doc has a few WC patients and won't accept anymore.

Regarding SSI/SSDI, there is a major misconception from claimants and many doctors about their input into a patient's claim. Saying the patient is disabled or can't work means nothing to SS. What SS does care about is the medical documentation of the patient's functional limitations, side effects from meds, long term prognosis, etc. Claimants are approved all the time without anything more than copies of their regular medical documents. Once in a while I'll hear that a doctor's office refuses to even forward medical records and that is a real problem. Anyone applying for SSI/SSDI should really do their homework about what's needed before applying. Since RSD/CRPS is not a Listed Impairment in the SS Blue Book, and because our symptoms and severity, and how frequently we can experience changes in those things, can make it easier for some and much more difficult for others to be approved.

BTW, it's not at all uncommon for a claimant to file for SSI/SSDI thinking they'll be approved with little to no documentation and then attempt to find a doctor once they realize they need it to prove they qualify. This is of particular issue in some parts of the country where application rates are much higher than the norm.

Hi Spike, I think you addressed this in a later post. Yes, definitely get a new doctor if they are not willing to fill out the necessary paperwork and fight for you. I am a bit removed from this as I went through all this so many years ago, I know it's so super stressful though each and every time you need to submit more paperwork. I just had to submit "I'm guessing" the short SSDI form, that was stressful enough and didn't even require anything from my doctor. Thoughts are with you all having to go through this :grouphug:

I am new here and have had many set backs recently and some possibly (I hope not!!!) bad news after MRI results Friday, so I am just extremely stressed (trying to be positive) and just want to help others to distract myself from focusing on what "could be". If anyone here needs support or wants to PM me for any help, please do so, I really need the distraction.

Paperwork has become almost a 4-letter word in the medical field. We (in the US) live in such a lawsuit happy country that we are taught to document everything to avoid being sued and in case you ever do end up in a legal situation your notes will help rather than hurt. There were days that I felt I spent more time on charting than time spent with my actual patients.

I agree with Lit Love about the amount of paperwork associated with WC is ridiculous. I keep copies of everything pertaining to my case including appointment summaries, radiology reports and any legal paperwork. I now have a large plastic tote to hold everything.

With regards to SSI/SSDI I was initially declined (as are the majority of people) but my WC lawyer is now handling my appeal. It made sense since he already had copies of my medical records. I had asked about letters from my treating physicians and he said not to waste my time because they usually don't even read them.

To go back to my original point about medical paperwork I would talk to your doctor and see if they would give a reason. I would not be surprised for them to say time is the biggest issue. I have not run into this issue as a patient but have dealt with it many times as a nurse.

Many years ago, ..... long before the days of HMO's, back during a time when health insurance meant "hospital coverage" in the USA, patients paid out of their pocket for ALL office visit fees. There was NO coverage for seeing a doctor in his office. Most lab work and imaging services done as an outpatient also fell into the category of no insurance coverage.

I was hospitalized during this period and had health insurance that would cover most of my hospital stay. The charges for the physician attending to my care IN the hospital was also covered but he charged a fee to file any insurance paperwork. I believe it was a $35 fee per admission.

In today's medical arena, most physicians will file any "health" insurance paperwork for free but any additional paperwork is difficult to obtain, such as disability, workman's comp, etc. Those that are willing, are hard to pin down and get it done. Others are only willing to do so for a nominal fee. And others flat out refuse.

When the paperwork is outside the normal course of routine health insurance filing, personally, I have no objection to paying a nominal fee for the service. It does take time and even if delegated to an office worker, the physician has to pay his/her employee.

This has been an interesting thread and has led me to think about medical charting in today's medical arena.

Now that electronic medical records are being required in the USA, how much of one's medical record is really accurate, depicts the truth of a patient's conditions, and how much is being charted in order to get claims paid.

My question relates to "possible" conditions that get charted that may turn out NOT to be accurate. When we go to the physician, we describe our symptoms. From them, the physician may order some tests before making a diagnosis, BUT, .... and here is what I question, in order to get the insurance company to pay for the testing, the physician must provide a diagnosis code. Let me give an example. Maybe the patient has symptoms that could be "gout". The physician orders a blood test, using the gout code, in order to justify the test. Is gout now and forever in your chart as a diagnosis even if it turns out to be something else?

In obtaining my medical records, I noticed that certain check boxes were marked off as being performed by the physician at an office visit and since I was the patient and part of the exam, I know for a fact that they were NOT performed. These check boxes were a requirement to be reimbursed by insurance and just automatically checked as done.

What good are medical records if they are NOT truly reflective of what actually transpired, what your diagnosis is AFTER test results have come back, etc. And now these records are being shared between medical personnel as an "aid" to our care??? How does an erroneous record aid patients? Seems to be that this could turn into a very detrimental situation.

I realize this is a little off topic but it is related so I thought I would put it here in this thread.

I understand the potential benefit of an electronic medical record, but I also see many problems with it. Just my opinion. Would love to hear others views on the topic.

I personally like computer charting for many reasons. The biggest one being continuity of care. I like being able to pull up a patient's chart and get a little background and be able to pull test results. When I worked in radiology a certain blood test is needed before we can administer contrast (it's a test that lets us know if your kidneys are working properly). I could look up the result if the patient had the test run either as an outpatient or inpatient. This eliminated time spent calling a doctor's office or trying to reach the patient's floor nurse. Another radiology example is in MRI when the patient had things like a stent placed but they don't have the card that goes with it so you don't know if it is MRI safe or not. I was able to look into the patients chart for not just my hospital but for any hospital in my network and know exactly which kind of stent was placed. This allows us to determine if they can get the MRI or not and which machine they can use.

As far as the diagnosis codes (ICD 10 formerly ICD 9) go they are primarily used for insurance purposes. If the doctor were to order a test or a medication without a code the insurance company would not pay for it. My personal opinion towards insurance companies is not a very high and I feel that have no right to dictate care. To use your example of gout if the test shows you do not have gout the doctor can remove it from your current list of health issues. Sometimes there is no code available for what the doctor did so they have to enter it under a different code. Also since most tests are done to rule out a condition that condition is not listed as a diagnosis just simply a reason for a test. I am not a coder so my knowledge is limited this is just what I know from my experience and both a nurse and patient.

I’m not saying that mistakes are not made, however computerized charting does cut down on errors and makes things easier on healthcare providers. There are always going to be doctors that cheat the system in hopes of making more money. When you find things in your chart that you believe are wrong I would ask about them and see what they say.

My favorite thing about computerized charting is not having to try and read a doctor’s handwriting! :wink:

Hi Hope,

This is in response to your very legitimate electronic records complaint. These parodies by ZDoggMD are hilarious and many are accurate IMHO.

http://www.youtube.com/watch?v=xB_tSFJsjsw

That is too funny! I hated dragging that stupid computer (we called ours COWS computers on wheels) just to have the batter die and going running to plug it in then search for a new one.

Medical Records
 

Lol! :thud:

The private practices are pushing the computer from exam room to exam room. The bigger teaching hospital has terminals installed in each room.

My records are so very erroneous. Worse than ever. They state I am taking meds I have never taken. It also looks like a computer program takes over to complete reports where a doctor has not finished commenting upon a part of an exam, because it was never done. The reports go on and on..."the patient denies a, b, c, r, s, t, u, v, w, x, y and z." None of these were ever discussed and if they were, these reports would be the opposite of what is reported. It's shocking.:eek:

I had called my doctor's office to see why I had received a copy of a specific and a very erroneous office visit note, when I don't usually receive them in this manner. The answer? Oh, we have to show an annual physical and we had to do a few things to make your last visit fit the criteria for an annual physical. If you have concerns about misinformation in the note, bring it to the doctor's attention at your next visit, six months from now. What about the erroneous info being read by all the various specialists in the meantime?(The appointment was an ER follow-up chat. No physical, at all.)

These computer systems/programs are used, sometimes, to be sure everything is meeting a regulation or a requirement, when it's a misrepresentation of what did and did not occur in the appointment.

It's disappointing, to say the least.:(

One of my doctors had left the room for a moment, although the computer screen was on, not closed. He ran back into the room and shut down the screen, telling me that HIPPA law says the screen cannot be left open, even in my own record, unless I give written permission to see my own record. :confused:

I am shocked with how many people can now view my record at the hospital. It's odd. The former paper record could have never been seen by so many.

I have on private doctor who keeps a paper record in addition to the electronic record, as he does not trust the electronic records system. He is concerned all records will one day disappear. ;)

Party On! :Head-Spin:

DejaVu

Oh my! In Canada its become something of a normal practice to have computers in all doctors officers (from the push ones to the installed in the room ones). It makes it easier to transfer doctor's offices and such. All the information is there if you are in an accident, etc.

Though, like Deja said, we too have to have written permission to see our record? Weird, but it can be done none-the-less. I'm lucky to have gotten doctors that read their appointment notes to me, and save them right then and there at the end of the appointment. I will correct the doctor on errors right then, and also remind them of the suggestions they've made, should they forget.

My records are full of errors. I have been listed as a he, having a cardiovascular disease.

Doctors have written that they took the pulses in my feet when they NEVER did. I thought I was crazy to not remember something so significant, but my husband who was with me told me the doctors did not do this.

Long expired prescriptions are listed giving the appearance that I am on tons of meds. I thought I had this fixed, but no-when I had my endo/colonoscopy I was grilled about all the prescriptions.

I am afraid to say much, because what I have said has been taken out of context and IMO makes me sound like a fruitcake.

Good and Bad
 

Hi NurseKris,

Thanks for your post. It is nice to get to see things from the other side of the coin. I, too, worked in the medical field but before a lot of the changes that have recently developed. (And before electronic medical records.) I worked in an acute unit in a hospital, also ICU and CCU.

I totally agree that having test results, labs, imaging, etc. available in an electronic record is beneficial. A list of prior surgical procedures, medications, etc. is also great to have available if accurate and updated.

And being able to read a typed note, instead of the scribble of many doctors is a definite plus, but what I have found is that is NOT always the case. Some docs are now scanning IN their handwritten notes instead of typing them. That loses one of the Biggest Advantages.

Let me expound a little on what perplexes me about the electronic medical record.

Two of my eight physicians have offered their patients "access to their medical record" online. However, the amount of access is very limited. I have access to my annual exam ONLY and nothing else from one physician. The other physician uses a program that gives the patient access to medication list, dates of office visits with the physician's notes. When I accessed this information, the note for each and every visit was word for word the same paragraph. It sounded like a "canned" paragraph that was picked from a group of possible paragraphs they use that best fits the visit but still very generic in manner. There was a great deal of missing information that is either not available to the patient to see, OR, the charting is VERY incomplete.

The canned paragraph includes information that is different than my experience during the visits. Tests that were performed in the office were not listed nor the results. The physician told me that my condition had worsened at each visit from the prior visit yet that was NOT included in the notes in the paragraph of which I mentioned.

If this is my "complete" medical record, it is VERY misleading and missing vital information. If it is not, then why are parts of the medical record being hidden from the patient? What parts will be shared with other medical personnel if necessary? The part I can view or the entire record?

To bring in a 3rd situation, a third doctor just moved his office practice into the local hospital. He uses an electronic medical record but does not offer access to patients. I have been seeing this physician for several years and have a procedure performed by him several times a year. I got a call from the hospital the day before my scheduled procedure asking for my insurance information. Where is the advantage of the electronic medical record in that? My doctor has that information in my record. The hospital obviously knew of the upcoming procedure, and all my other information, so why did I have to provide my insurance information separately?

From the information I have "SEEN" in my so-called medical record, it is not only erroneous but incomplete and I would sincerely hope that another physician would not rely upon it.

I do agree with some of the points you have made but the flip side is not a positive in my opinion.

Dear DejaVu,

Thanks so much for your post. I have known my PCP for 35 years. Since he started using an electronic medical record, I feel like I am ignored. I sit on the exam table and he interacts with the computer, NOT me. He is so busy going through all the different screens, just checking off this and that, that I might as well not even be there. Oh, eventually, he finally leaves the computer and does an exam, but he appears to be much more interested in whatever is on that darn computer than what is wrong with ME.

This is so out of character for this physician. I have known him way too long. This has changed him so much and how he practices medicine. Even if he is the same in his head, the perception is that I am being ignored. I don't appreciate sitting there looking at his back while he is busy looking at a computer screen.

Even the demographics change when they hit the wrong box on the screen. Females become males and vice versa by the slip of the mouse. Widows become divorced.

The only thing that they seem to enter correctly is my weight and I wish they would hit a lower number for the middle digit. Why can't they make a mistake where I would appreciate it?

Dear BioBased,

I know exactly what you mean about things being charted as done that were NOT done.

We are there and we are not forgetting what has been done, or NOT done.

Types & Erases... Types again and Erases... Types again.. and ahhhh errrr ERASES... *GULP.... (RUNS And Hides) Just looks at the ending question and stares from a galaxy far far away!