I’m still not done with this claim. I gave up after a couple of hours. I imagine I’ll be spending a good chunk of my weekend on this.I am currently trying to submit a claim for out-of-network services to my health insurance. I’ve done this before with my old insurer, Blue Cross Blue Shield of Massachusetts, and I thought that process was abstruse, but it wasn’t too odious and it got done to my satisfaction. Well, my company recently changed insurers and I now realize how spoiled I was. I would just like to take a moment to talk about the claim form I am faced with and what it demonstrates about the unfathomable levels of stupidity that humans are capable of.

The form my new insurance carrier uses is the CMS 1500. It was developed by the National Uniform Claim Committee, ostensibly to provide a single, common claim form that everyone can use. It is the standard form used to transmit claim information for Medicare.

If you wish, you can download the CMS 1500 form (PDF)

I had never seen it before. At first glance, it’s impenetrable, confusing, and horrible. Look closer, however, and you will find that it’s also diabolical and evil.

I had no idea how to actually fill out this form, so I went looking for some help. I located the maker of the form (the NUCC) and found a handy instructions document that I could download (you can too here).

The first thing to note here is that the form is one page. The instructions are 56 pages. Really.

Now, the instructions are really helpful. That’s because the form itself is not. A couple of my favorite gems from the instructions include line 9:

Oh, yes. Don’t know how to fill in question 9? Idiot, that’s because you haven’t answer question 11 yet.

And then there’s the part of line/section 24 (where you actually enter the services and charges) that asks for the location of the service. The box for this is very small, so I didn’t know what to enter. I consulted the instructions and found that, naturally, I’m supposed to enter a code. What code? Well, that would be detailed in an entirely separate document called Place of Service Codes. I’m really not kidding:

That’s another 6-page document.

That’s all well and good, you may say, but stop your bitching and suggest something better. Without actually redesign this monstrosity, I can suggest a few principals to work from:

1. Use plain language labels for your fields
2. Try to keep topics together vertically - it reads better
3. Do not have questions dependent on questions that come later
4. Really think about your terminology. “Insured”, “patient”, “provider”, “referrer” all can be ambiguous. Don’t be afraid to use more words to make things clearer.
5. Don’t, for the love of god, be afraid to use a second sheet of paper
6. Hierarchy. Damn, I can’t emphasize that enough - hierarchy. Some stuff is more important than other stuff. Make it bigger. Use spacing. Break up that uniform gray page.
7. Use space to separate clusters of things that go together
8. There is a community of people who are trained designers and actually design forms for a living. Find one and pay him/her to fix this.

I’m still not done with this claim. I gave up after a couple of hours. I imagine I’ll be spending a good chunk of my weekend on this.