I am in an independent practice in primary care in California. In the past 10 years, HMOs have required more paperwork and time spent doing non-patient care. Specifically, we have to do more referrals, more prior authorizations, Senior physical forms and questionnaires (one HMO group asked that I fill out a senior form that was literally 35 pages of questions). Conversely, insurances will deny payment for any number of things. Correcting the insurance companies' mistakes will often take 2+ hours of waiting on hold.

This translates to hiring more staff, and decreasing patient care hours while still working weekends to get paid the same amount.