Among the increasing number of mandates that are raising health care costs are new paperwork burdens, say managed care officials. For example:

• Under the Women's Health and Cancer Rights Act of 1998, every health plan must send a notification to every man, woman and child on its mailing list about the newly mandated benefits for breast reconstruction following cancer surgery -- including plans that already covered such procedures.

• To implement the patient bill of rights, the Department of Labor has recently proposed regulations requiring health plans to send emergency room patients a summary of bills paid and what is owed -- even if the bill is paid in full.

• Furthermore, if visiting the emergency room required an authorization from the health plan, the new regulations require the plan to send a notice to the member and the health care provider -- even if there is no dispute, which is the case in 95 percent of all requests.

• Finally, the Balanced Budget Act of 1997 requires all Medicare beneficiaries to receive a brochure describing all their coverage options; but the Health Care Financing Administration is requiring Medicare Health Maintenance Organizations to pay the entire cost, even though they cover only 15 percent of all Medicare beneficiaries.

An official of UnitedHealthcare says it had to send out six million notices of the breast reconstruction mandates, which cost as much as 40 breast reconstruction surgeries. Furthermore, the $9 million the plan spent on the Medicare notification could have provided 9,000 Medicare members with $1,000 each in prescription drug coverage.

UnitedHealthcare recently closed its Medicare health plans in 86 counties because health care costs and administrative expenses exceeded the set premium paid by the government in those counties. Company officials say that for the cost of the Medicare mailing they could have kept Medicare HMOs going in 10 of the counties.

Source: Lee Newcomer (chief medical officer, UnitedHealth Group), "Paperwork Is Bad for Your Health," Wall Street Journal, January 11, 1999.