Paperwork is driving up health care costs by as much as $9 billion annually in California, according to a public interest group that suggests physicians and insurers spend way too much time on processing insurance claims.

In California, physicians typically spend about 45 minutes a day on insurance paperwork, according to a report released Thursday by the California Public Interest Research Group.

"If we can do it more cheaply, it's a win-win for everybody," said Michael Russo, a health care advocate and staff attorney with CalPIRG. "When costs are skyrocketing, it's best to go for the low-hanging fruit. This is an area where we spend a lot of money."

In all, CalPIRG estimates that $9 billion is spent by insurers and medical practices in California to process insurance claims.

"It's just ridiculous," said Dr. David Kosh, a family physician in Sacramento. He said his billing staff spends most of its day on the phone with insurers.

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