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What You Need to Know About Medical Billing Errors Past Age 65

Contributor

Updated December 3, 2024

A woman reads medical bill while she sits in a chair next to her medication.

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Medical billing errors can happen to anyone. But according to recent findings from the Consumer Financial Protection Bureau, you may be more likely to experience these errors if you’re age 65 and older.

As you get older, the system makes these billing errors more difficult to correct, which means they may hold more potential to hurt your credit score — no matter how erroneous the charges may be.

Still, despite the greater likelihood of errors as you age, there are ways to fight back. Let’s take a look.

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Why You’re More Likely to Face Medical Billing Errors Past Age 65

There are several reasons why you’re more likely to face medical billing errors as you age. Here are the big four to consider.

You go to the doctor more often as you age.

We’re all mortal and likely to face more health issues as we age. As you interface with health systems more often, you become increasingly likely to encounter billing errors — even if everything else was held equal. (Which it’s not — we’ll get to that in a minute.)

Think of it like this: Everytime you go to the doctor, let’s say you’ve got a 25% shot of running into a medical billing error every visit. (The real number is much higher, but this is just an illustration.) If you only visit twice per year, you might get away with not encountering a billing error. But if you’re going to the doctor twice per month, you’d be lucky to walk out with fewer than six medical billing errors per year.

Your billing codes are more likely to get flagged.

As you start encountering chronic health conditions and requiring complex healthcare, your doctor’s office will start typing different codes into your file. Codes for complex health issues typically pay out more, so insurance carriers flag them almost any time they come through. That means that the type of care you’re getting inherently makes you more likely to encounter these billing issues.

You’re more likely to have multiple insurance policies past age 65.

You’d think more insurance coverage would be good, right? That is, afterall, the purported intent of programs like Medicare, Medicaid, Tricare, etc.

But as it turns out, more insurance just means more opportunities for insurance companies to get it wrong. Everyone has a different system, and the one system this country has where they can all interact with each other is rife with communication breakdowns. All of this leads to no one picking up the tab — even when they should have. And guess who’s left holding the bill?

That’s right. It’s you.

You’re more likely to be dealing with executive function issues.

When you start layering all these different health insurance programs on top of the already opaque medical billing practices in this country, you get a very complicated system. It’s a system that produces errors up to a whopping 80% of the time. It can’t even navigate itself. It’s not reasonable to expect everyday people to know how to navigate it as they attempt to self-advocate.

Yet that’s exactly what happens. Plus, as you get older, you’re more likely to encounter certain circumstances that put you under a lot of stress. You may have been forced to sell all your assets in order to access adequate health care coverage and services, leaving you on a fixed income. Poverty is a massive cause of stress.

If your health is being negatively impacted as time goes on, you’re also dealing with the stress and medical trauma that often accompanies these issues. It’s also unfortunately true that in our culture, as people age we tend to push them out, leaving many in a stressful state of isolation.

You can combat the isolation with these free and cheap activities for seniors to get better integrated into your own community.

Any human performs suboptimally when they’re under a lot of stress. So when it comes to figuring out how to navigate an unnavigable system, you might just not have any bandwidth left to pursue it. That’s understandable. But it’s also likely to get worse, as even incorrect line items on your credit report can hurt you financially.

What You Can Do to Fight Back Against Medical Billing Errors

Not all is lost. While it’s very difficult to get medical billing errors resolved, it’s not impossible. There is a path forward.

Research your rights.

Not all insurance companies bill legally. I once got a rejection letter after I made an appeal that explicitly stated a reason for refusal which is illegal at the federal level. Had I not been a finance nerd who had just written a piece on this specific piece of federal regulation, I wouldn’t have caught it. But I did catch it.

I appealed again, this time quoting federal regulatory agencies. After calling out the illegality in writing, my claim got covered at lightning speed.

It’s a lot to research health law. But thanks to the internet, it’s infinitely easier than it was 20 years ago. One of your first steps can be running a simple search to see if the reason for denial is blatantly illegal.

Enlist help.

Even if you can find a law, understanding what it means in context of the larger system isn’t always possible on your own. Getting some help from an expert can be key. Luckily, you can secure that help for free through organizations like Dollar For.

You can also get free help with your Medicare or Medicaid billing by getting in touch with your state’s Consumer Assistance Program. Not all states have a CAP. All states do have a Protection and Advocacy organization, though. While this agency’s purpose is broader, it can still be a great resource — especially when CAP isn’t available.

If things are bad enough and you understand them well enough to argue your point, it may be time to enlist the help of a regulatory agency. Here are some places you can turn:

Your state’s Attorney General’s Office may have a system for handling these complaints.
Medicaid and Medicare complaints can be submitted to CMS.
Complaints about medical billing issues showing up on your credit report go to the CFPB.

Use financial assistance programs in a pinch.

A major problem with medical billing errors is that it’s almost impossible to get them resolved before they end up on your credit report. So even if you want to fight it, it may be more practical to just get the bill covered before it gets sent to the reporting bureaus.

If you got care at a non-profit hospital or through a doctor associated with a non-profit hospital, you can apply for financial assistance. The Affordable Care Act mandates that non-profit hospitals offer financial assistance, and it can wipe out a portion or even the entirety of your bill.

While the ACA doesn’t mandate coverage levels, the income limits at most hospitals are higher than you might think. The general rule is to apply if you make up to $100,000 per year, but if you live in a higher-cost-of-living area, you can bump those income limits up as they are based on the local cost of living. If you’re living on a fixed income, you’re almost guaranteed to qualify.

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In the future, medical bills may not show up on your credit report.

The CFPB is currently implementing measures that would eliminate medical bills from your credit report, but how that will actually function remains yet to be seen. In the past, we’ve seen new credit scoring models introduced that minimized the impact of medical debt, but very few lenders ended up using that particular FICO model to determine credit eligibility. There is reason to hope in the near future, but we don’t know what that hope will look like just yet.

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Pittsburgh-based writer Brynne Conroy is the founder of the Femme Frugality blog and the author of “The Feminist Financial Handbook.” She is a regular contributor to The Penny Hoarder. The Penny Hoarder staff also contributed to this post.