Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out -- known as E.O.B.'s -- are filled with unintelligible codes.
The system is so impenetrable that it mystifies even the most knowledgeable.
''I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do,'' said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. ''I can't figure out what care it was related to or who did what.''
Dr. Blackford Middleton, a professor at Harvard Medical School with special training in health services research, said he did not fare much better than Dr. Brailer.
''I understand the words of diagnoses and procedures,'' he said. ''But codes? No. Or how things are paid or not paid? I don't understand that.''
Dr. Brailer said he often used an analogy to describe the current state of medical billing.
''Suppose you walk into a restaurant,'' he said, ''and you don't get a menu, you don't get any choice of what food you'll eat, they don't tell you what it is when they're serving it to you, they don't tell you what it's going to cost.''
''Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don't, and although you get the bill, you still can't figure out what you really owe,'' Dr. Brailer said.
Some people make valiant efforts to sort through bills and claims, but end up throwing up their hands; others ignore them, until they are pursued by collection agencies; still others, basically healthy but weary at the prospect of a paperwork fusillade, stop going to the doctor altogether.