Transcript
CFPB FinEx Webinar: Medical Debt and Older Americans
October 26, 2023
Presenter:  Hector Ortiz, Office for Older Americans, CFPB; and Kate Kramer, Office for Older Americans, CFPB
Facilitator:  Ken McDonnell, Financial Education Program, CFPB
  
 >>Robin Dixon-Jefferson: Good afternoon, everyone, and thank you for joining us. My name is Robin Dixon-Jefferson from the Bureau's Events Management. I'll go over some logistics before we begin.
 
If you are having any issues with your audio, click on the Audio and Visual button, which is located at the top of your computer screen. There, you will receive guidance on switching your audio to your telephone. If you require closed captioning, the Webex-generated closed captioning can be activated by hitting the CC button, which is located on the lower left-hand corner of your computer screen. If you need technical support during this event, please use the chat box function. Click the down arrow to chat to host so that someone can provide you assistance. For the record, this event is being recorded. So your participation is saying that you agree to having your voice or likeness, if you come off camera, on camera, displayed on the screen.

With that being said, I will now turn this over to Hector Ortiz, who will officially get this event started for this afternoon. Hector, you now have it. 
 
>>Hector Ortiz:  Thank you, Robin, and good afternoon, everyone. Thank you for joining us to talk about the problems that older adults may experience with medical bills and debt.
 
At some point, we and the people that we love will face a problem with a medical bill. Either we cannot pay it fully or the medical bill has an error. These are common issues, and one that affect millions of Americans, including those with good insurance, and one that certainly affects those who have the greatest needs for access to health care.
 
At the CFPB, we work to protect consumers from medical debt and to ensure that if medical debt is going to be reported to collectors and credit bureaus, that it's done accurately and that people are treated fairly when they're dealing with collectors and credit reporting agencies.
 
And today, we're going to share some information about medical debt and how you can use this information to teach your clients, older adults, as well as caregivers, about protecting themselves and managing their personal finances.

I am Hector Ortiz, and I work with the Office for Older Americans at the CFPB, and prior to joining the CFPB, I worked at the National Council on Aging, where I worked on issues related to benefit access, including access to help with Medicare costs. And I'm joined today by my colleague, Kate Kramer, and Kate brings a wealth of experience and passion for these issues too. She's a former legal aid attorney who served older adults in an agency on aging in Florida before joining the Consumer Financial Protection Bureau's Office for Older Americans.
 
Please type your questions into the chat box. Throughout the presentation, we'll take a look at the chat and answer your questions at the end of the webinar, and again, a reminder that this webinar is being recorded.
 
Next slide. So what is the CFPB? Many of you have been in this webinars before, but for those of you who are new to these webinars, the CFPB is a federal agency. We were created in the wake of the 2008 mortgage crisis, and we're dedicated to protecting consumers, you, from unfair, deceptive, and abusive financial practices. Through our enforcement work, our supervision, regulation, research, market monitoring, we work to ensure fairness in the markets for consumer financial products and services. We work on medical debt, debt collection, and consumer financial risk in the marketplace for long-term services and support too.
 
Next. Within the CFPB, we have an office that is exclusively dedicated to the financial protection of older adults and caregivers. We protect older adults and caregivers by gathering information from people like you about the consumer protection risks that people face, and after today's session, I hope you approach us and stay connected with us to talk about issues related to medical billing and debt collection issues that you may see in your communities. With this information and feedback, we coordinate federal and state efforts, and we also provide you and the people you serve with the tools for meeting these challenges.
 
Next slide. And today, Kate and I will be presenting on behalf of the CFPB, yet our opinions and views may not represent the Bureau's view and are our own.
 
Next slide. So in today's sessions, we will be talking about four main topics. First, we're going to talk about the relationship between inaccurate billing and medical debt. Then we're going to talk about how inaccurate medical billing is reflected in the complaints that we're receiving at the CFPB and also in national surveys and how challenges and costs related to long-term services and support relate to medical debt too, and then finally, we're going to share some resources that you can use to address debt collection on inaccurate bills.
 
Next. So let's start with what we know about inaccurate billing and medical debt.
 
Next slide. So on July 28th of this year, the Kaiser Family Foundation covered a story of a Medicare beneficiary who was sent a debt collection letter from an unpaid bill related to an anesthesia procedure that the person received after a surgery. Turns out that the provider pursued the beneficiary instead of billing Medicare on time. The provider sent the debt to collections before even the person discovered the problem, and Medicare eventually received the claim from the provider. But Medicare denied it because it was filed 17 months later after the surgery.
 
Next slide. So this is the example of a bill that's provided, of a bill the consumer received in discovering this new story. The total bill, again, was about $3,000 in an amount that for some people can cause major disruption of their monthly finances and certainly deplete the small savings that they have. We hear countless stories of people who pay these bills because they don't want to deal with resolving the problem and dealing with the paperwork or the problem. And again, these are common in stories that we see.
 
Next slide. So one reason we see these stories is that medical error and medical billing errors are common. Even at a small prevalence rate of 7 percent, this translates in a system that addresses millions of claims. It's a significant number of errors. Several companies that work in this space of claim management and revenue cycles for health care providers state that approximately 60 to 65 percent of denied claims are never resubmitted. This means that consumers may end up paying bills that they don't actually owe.

And in a 2022 survey that Kaiser Family Foundation ran, they found that 44 percent of adults that had an unpaid bill in the past five years reported that they did not pay the bill, that one of the reasons, again, they're carrying that unpaid bill was because they were not sure about the accuracy of that bill.
 
Next slide. So what are some of those sources of the inaccuracy? When we looked at broadly the literature, what we find is that some of the common errors are invalid claim data are missing, issues around authorization and precertification, missing medical documentation, incorrect billing codes, as well as untimely filing of the claims, which, again, contribute to the rejection of a claim that will otherwise be paid. And many of these errors, again, are likely avoidable and fixable, but a fraction of them are of this—these claims that are rejected are resubmitted and adjusted.
 
Next slide, please. So prior research tells us that inaccurate bills and denials are common for people with multiple payers, ad this is a very common situation for Medicare beneficiaries who typically rely on Medicare plus some other form of coverage to cover some of the gaps in Medicare. In fact, a 2018 study on billing complexity precisely found that the highest denial rates were for programs such as for beneficiaries with Medigap and Medicaid, again, because of the complexity of involving two insurances.
 
A 2014 study by CMS also documented some of the challenges that people with Medicare and Medicaid dual-eligible beneficiaries face in those related to balance billing of this population for Medicare cost sharing, and that, again, that unpaid bills were submitted to collection agencies. And then we also know, again, that people do pay some of these bills, even if they don't know it, because, again, they were not—they don't have the ability to determine whether it was accurate, but also they didn't want to deal with the complexity of the issue.
 
Next slide. And so for older adults, these are common issues, and they're exposed to, particularly to all of these risks of inaccurate billing for a number of reasons. One of it is that they have a higher incidence of multiple chronic health conditions, which tend to require complex medical care. This often translates into higher intensity medical billing codes, which are often used to seek higher reimbursement rates. And these billing codes, again, provide for larger payments, but at the same time, they also require a lot more documentation as well as they get higher scrutiny by insurers, because there is a concern, again, around upcoding and overuse of these codes.
 
And then the second thing is that older adults, again, are more likely to rely on the insurance plans, multiple insurance plans, which means that the transfer of claims and the coordination of those insurances—it's pretty common. In fact, 68 percent of those older adults who have unpaid medical bills were covered by two or more insurances.
 
And lastly, we're dealing with a population that as you go up into the age ranges, you have greater challenges, not only in terms of access to the internet to search a claim and certain information, but just simply just the detection, correction, and the ability to address some of those bills and navigate the system.
 
Next slide. As I said, our agency focuses on financial products and services, including credit reporting, credit cards, debt collection. So we see medical debt when it affects people's credit, when it is sent to collectors, and when, for instance, people are struggling to pay a medical credit card. And we see these problems primarily through complaints that consumers will send to the CFPB.
 
Next slide. And so we accept complaints, again, on a wide range of products and services, and we help consumers connect with the financial companies to understand the issue, fix the error, and get direct responses about the problems. And again, this is a way through which we learn about the particular issues that consumers are facing in the marketplace. Often consumers solve these problems directly with the company. So when they're unable to do so or they're not getting a response, they usually will submit a complaint to us. And that is, again, how we learn about these, and we make some of these complaints public with the consent of consumers. So you can go to our website and learn, again, about the issues that consumers and older consumers are facing in these different markets, including medical debt.
 
Next slide. So this is an example of a medical debt complaint that we received from a Medicare beneficiary, and again, it shows that they are being collected for a balance that—for a remaining balance of a claim, despite their efforts to show that they were not liable for the amount. And again, the collections persisted. It also sort of talks a little bit about the stress that consumers are feeling, the anxiety that this is causing. And some of these problems are not just a one-, two-month thing. Some of these are going for one year or more. And again, we see hundreds of complaints like this.
 
Next slide. In May of this year, we published a report. We analyzed some of those complaints, and in that report, we perform an analysis of our complaints that were received between March of 2020 and December of 2021. And we were really surprised that despite the universal insurance coverage and that, again, most surveys do show that older adults are less likely to have medical debt than older adults, the presence of medical debt complaints were higher, are relatively higher for older adults, as a total of all the complaints that we received then for younger adults.
 
Next slide. And that when we looked at the reasons or the main reasons why people were complaining was that they were saying that the collector was trying to collect on a debt not owed, and that was an important factor, again, consumers alleging that they did not owe that debt.
 
Next slide. And even further, when we looked into those categories and we divided between the old general Medicare complaints and those that were submitted by people who said I have Medicare plus TRICARE or Medicare plus Medigap or Medicare and Medicaid, that the rate of attempts to collect debts not owed was significantly higher on the category of multiple insurances, and again, a surprise, given that those are the people with better insurance, and yet this aligns with some of the research that I presented before about the complexity of the system and how it leads to higher likelihood of inaccurate and the erroneous billing. And a lot of the complaints that we saw were precisely about they did not file on time, they failed to even file to a second insurance, they're charging me for the remaining balance for after charging my two other insurances, which they're not allowed to do so because of their contractual agreement. And so again, these are the complaints that we saw primarily from Medicare beneficiaries in our database.
 
Next. And, of course, we also have to look at this from the bigger picture and what the national data says about these issues. And one thing that I just want to say straight is that what we found is something that we all sort of know very well, that insurance does matter. It does protect people from medical debt, and so it is certainly older adults who have mostly universal insurance through Medicare have a lower rate than their younger peers. So older adults, 7 percent of them, reported unpaid medical bills compared to their younger counterparts, yet at the same time, when you have a population that is generally covered, issues around unpaid bills relate again to insurance issues. And one of the things that we found is that the vast majority or large portion of these individuals with unpaid medical bills were people with two or more sources of insurance, which generally are in this Medicare system. These are the extra insurances that will cover for dental, vision, will help afford the cost of Medicare that's particularly through Medicaid or Medigap. And again, this extra insurance is intended to, again, cover what Medicare does not cover.
 
And another surprising finding was that between 2019 and 2020, the amount of medical bills increased by 20 percent, and that was another surprise to us because of what we know about generally the Medicare program has done over the last couple of years to serve improve access to benefits. But most importantly, because in the pandemic, we saw a significant decline in the number of doctor visits, fewer people underwent elective procedures, and so there were a lot of things going on during that year. And in the percentage, again, that 20 percent, is much higher than the average growth in the Medicare cost sharing, the premiums, and other components. 
 
So another thing that—next slide—we found in looking at the general data was that there was a pretty high percentage of people with duals had a higher rate of unpaid bills compared to others. And again, this is a population that past research has flagged as dealing with inaccurate billing, but also our complaints also flagged lots of issues of people with Medicare/Medicaid complaining about debts that they don't owe. This population is not small. There are about 7 million older adults who are enrolled both in Medicare and Medicaid, and the key characteristics of this population is that they should have little or no out-of-pocket expenses, Medicare expenses, because they qualify and receive Medicaid assistance with Medicare premiums, coinsurances, co-payments and deductibles. And yet again, we do see high levels of unpaid medical bills, despite these protections. These protections are vital for this population because they tend to have the lowest income and assets as well as the greatest health care needs.
 
And just also to know that the vast majority of duals are what we call "full duals." So these are people who are also getting an additional set of benefits such as hearing, help with hearing, dental, and vision care, which are not additionally not covered through Medicare. 
 
And then again, this is not just federal protection, also federal, state laws—state laws also prohibit providers from billing certain dual eligible beneficiaries. 
 
In the next slide, we have, again, the comparison of those rates, and you can see again what I said that insurance matters. So the uninsured and those who only have one source of insurance, typically Medicare only, tend to have a higher rate, but yet we see people with Medicare and Medicaid, Medicare and TRICARE having higher than the average percentage in terms of—which is 7 percent for all older adults. But again, those bars in blue represent 70 percent of those with paid medical bills.

One last thing that I want to say about those who have multiple insurances is that in the system, particularly the system that relies—that is used for claims for those who are duals, those who are in the dually eligible beneficiaries, Medicare and Medicaid, that system often is a very complex system in that you have states and territories. So you have Medicare that has to be billed and the states in some cases, and now you also have a lot of Medicare special needs, Medicare Advantage plans in this space too. So it is certainly a complicated space in some states, for instance, will only accept paper claims files. So there are some issues in this space that do explain why, again, duals may be liable.
 
One of the things that we want to say here is this is a very complicated population in that some of those may have transitioned into Medicare with debt accrued prior to becoming eligible to be duals, and some of those, as you all know, from any public benefits, some of those transition in and out of the program for a variety of reasons. And yet we did explore those two possible explanations as to why, to determine whether those were the reason why dually eligible had a higher rate, and they did not seem to be the major predictors on this. What we found, in fact, was that the rates were different—were similar for those who transitioned. The vast majority of the people were consistently enrolled through the year.
 
Now I will pass on to Kate, who's going to talk about the issues related to long-term services and support. And I don't know, Kate, if there was any particular important question that needs to be covered at this critical juncture.
 
>>Kate Kramer:  I think we've answered most of the questions in the chat, but I can go ahead and just read them out for those who may not have access to the chat. 
 
So we had a question:  Didn't medical collections reporting stop? I thought that was changed, no longer able to be reported on credit reports. And someone else had a similar question:  Do medical collections still get completely removed from the credit reports if the person settles the debt? 
 
And so I did share some resources in the chat for those who have access, but the CFPB is undergoing a rulemaking process to remove medical bills from credit reports. And so there's information about that on our website, that rulemaking. 
 
And also earlier this year, Equifax, Experian, and TransUnion did remove all paid medical debts from consumer credit reports, and they also removed medical debts less than a year old. And they're also working to remove medical debts under $500. So that went into effect earlier this year, and that affects about half of people who do have medical debt on their reports, but there are still lots and lots of people who have medical debt in their reports and are experiencing debt collection and have all kinds of other related issues that we'll talk about today. So if you do have access, feel free to check out those links and you'll see some information on our website. 
 
I think there was one other question:  Just what does balance billing mean? And to define that, basically it's when a provider will bill the patient for the difference between the charge that the provider normally charges and the allowed amount, so the contracted rate with the medical insurer. So there's an example that I shared in the chat where if the charge is normally $100 and the allowed amount is $70, then the provider could bill the patient for the remaining $30, and that would be balance billing, but that is not legal with Medicaid and Medicare. So preferred providers can't do that. And so there's information in the chat about this, and feel free, if you have other questions, stick them in. 
 
It looks like there are a couple more coming in. I'm going to jump into the long-term services and supports real quick, but we can come back around to answer some of these questions after I finish up, if that's okay. Just want to make sure we get through everything before we get to the Q&A. 
 
So how do long-term services and supports relate to medical debt? This is an area that our office is really focused on. There's a lot of challenges people experience related to long-term services and supports.
 
Next slide, please. And the costs of long-term services and supports often relate closely to medical costs. Older adults and caregivers, both are often dealing with medical billing, medical debt, and this includes that cost of LTSS. I'll abbreviate it too. And we know after age 65, about 70 percent of people will have some LTSS needs. Twenty-two percent of people can expect to have these types of needs for more than five years, and 35 percent of people after age 65 can expect to spend at least one year in a nursing home. So, essentially, lots of people are going to need this type of care, and it's typically very expensive.
 
Next slide. We know most people don't have long-term care insurance, and there's a big gap often between the high cost of long-term services and supports and the resources that people actually have to pay for them. In one study, we found that less than one-third of single respondents and 57 percent of couples had the financial resources in their first wave of full retirement to pay for both five years of regular expenses and a six-month nursing home stay. Similarly, 31 percent of single folks and 53 percent of married households can cover six months of part-time home health care on top of the five years of regular expenses. So if you think about that six months of part-time home health care, it is sort of on the lower end likely of the cost spectrum of long-term care, and that's even something that is very difficult for people to cover.
 
We know often caregivers provide some financial support to older adults. They sometimes help to fill that gap between the costs and the actual resources people have. There was a survey in 2021 on family caregivers, so that doesn't include paid professional caregivers. And AARP found that family caregivers were spending an average of $7,242 a year to support the person that they were caregiving for, and again, that's just the average. So there's people spending much more. And about half of that was spent on housing. That includes rent and mortgage payments, as well as home modifications, assisted living costs, relocation costs. So caregivers are frequently dedicating a significant amount of their own money to help out with housing costs for the person that they're caring for. And around 17 percent of the money that caregivers spent was on medical expenses, including medical provider and hospital payments, including nursing home care, in-home care. And so in addition to caregivers who may contribute some of this, the costs are very high and older adults may look to other financial products to try to fill that gap between the costs of long-term care and their existing resources. 
 
Next slide, please. So in your work, you may have had people ask you, how do I pay for this? How do I pay for in-home care or assisted living or skilled nursing care? And this slide shows some of the many ways that people may pay for these long-term supports and services. Often people have to get very creative because, as I mentioned, it can cost a lot for this care, and people can very quickly deplete the assets that they do have. 
 
So there's private long-term care insurance, and again, we know most people don't have it. Paying for this can also be cost prohibitive. The costs have been rising in recent years, and there also may be carve-outs for specific services or types of care. So it's not always full coverage.

Retirement savings. We know that 47 percent of men and 50 percent of women have no retirement savings at all. So some people can use savings, but this isn't an option for many people.
 
Home equity. There are different ways that people may try to access the equity in their home to pay for care, and each of these comes with its own benefits and drawbacks. And CFPB has resources to help people figure out whether any of these are right for them. But there are options like cash-out refinance, home equity loans, home equity lines of credit, reverse mortgages. And we do have a lot of resources on particularly reverse mortgages, but some of these others are as well on our website. 
 
Pensions. Fewer and fewer people have access to a pension, but for those who do, they might be able to use that money to pay for care. And cashing out assets. So people might try to cash out their pension and take a lump sum, or they might cash out life insurance to get money to pay for their long-term supports and services. It's also interesting to think about some of these different mechanisms. People who use, for example, a credit card to pay for their medical bills might not think of that unpaid credit card balance as medical debt, even though it is. It was used for that purpose. And as Hector mentioned, our office is really interested in learning more about a lot of these topics, so including the types of financial products and services that are being marketed to older adults to pay for long-term care. There are a lot of products that are marketed as methods to get quick cash for health costs and things like that. And we'd love to hear what you're seeing in your work with older adults.
 
Next slide, please. So one part of our office's recent work involved protecting caregivers from experiencing debt collection by nursing homes for their loved one's debts, and when nursing home bills aren't paid, sometimes nursing homes will hire debt collectors, including law firms, to demand that caregivers pay for the resident's unpaid nursing home bills. They also might report the debt to consumer credit reporting companies and say that it's the caregiver's debt, and they might file lawsuits in court. Debt collectors might even tell the judge that the caregiver intentionally misused or hid or stole the resident's funds even if they have no reason for believing that the caregiver actually did that. So these actions could violate the Federal Fair Debt Collection Practices Act or the Fair Credit Reporting Act, but that doesn't mean that they don't happen.
 
In early September, our agency released a report which was a joint letter with CMS, and that had information for state, federal, and private enforcers of consumer financial rights. So we have an issue spotlight that highlights how nursing home debts can arise. It also looks at problematic nursing home admissions contract provisions. It looks at debt collection practices by nursing homes, and it looks at the difficulties that caregivers experience when they are pursued over their friends' or family members' nursing home debts. 
 
Then when we did that report, we also worked together with CMS, the Centers for Medicare and Medicaid Services, and we issued the joint letter I mentioned that reminds nursing facilities and debt collectors of their responsibilities under several different laws, including the Nursing Home Reform Act, the Fair Debt Collection Practices Act, and the Fair Credit Reporting Act. And to promote enforcement by state agencies and other federal agencies, as well as consumer law attorneys, we released a Consumer Financial Protection Circular, which explained that attempts to collect debts from caregivers based on contract terms that violate some of these different laws are problematic, and that it's not, you know, false claims of wrongful financial conduct may violate these various federal laws. So please take a look at our website. 
 
And next slide. You can find our reports on medical debt and the ones that are particular to older Americans at our CFPB policy page on medical debt. You can see it here on the website, ConsumerFinance.gov/medicaldebt.
 
Next slide. Okay. So now that we've taken that detour into long-term supports and services, I want to dive into the resources and options that exist for helping people who are experiencing problems with debt collection on inaccurate medical bills.
 
Next slide, please. I hope those of you on the call who might be with area agencies on aging or other community organizations will not be surprised to learn that we send folks to those of you who do work in the community, including state health insurance assistance programs, or SHIPS. If you're helping someone with Medicare who is experiencing medical billing or debt, you can refer them to speak with a health insurance counselor. That person can help them figure out if they're eligible for additional services or financial assistance, but the costs of prescriptions, premiums, co-pays, and coinsurance. So that's a great resource.
 
Next slide, please. We also have a blog post that explains what people in the Qualified Medicare Beneficiary program can do when they get a bill for charges that should have been covered by Medicare. One thing I just want to note is that it's really important to gather the information and documentation first, which sounds easier than it probably is because there can be a lot of documentation to look for, but the first step really is to contact your provider. Ask for insurance documentation. You really want to validate the charges and that's important because sometimes the people contacting you or trying to bill you for charges could be scammers, and we'll talk about that in a moment, how to look for those red flags. But having all of this documentation on hand is important because practices may change owners. Medical practices might change their systems for their documentation, and we read about issues in our complaints about sort of information getting lost or mistranslated and people getting wrongfully billed. You also want to ask for the reason for denial. Maybe they said you have the wrong Medicare ID number or there's some other reason that they can provide you with, and the insurance company can also tell you if the claim was submitted. So to find this blog post, you can type into a search engine "CFPB" and "wrongfully billed for Medicare," or you can just go to our website and enter "wrongfully billed for Medicare" into the search bar at the top. 
 
Next slide, please. We also have information on whether debt collectors can garnish federal benefits like Social Security income or veterans benefits. These types of federal benefits have protections associated with them. So it's really important again for the consumer to verify the debt. It's important to talk to an attorney and respond to any court filings before paying anything to the debt collector. So to find this information, again, you can search online in a search engine or you can visit our homepage and type in garnish benefits in our search bar. 
 
Next slide, please. Debt collection scams. So one thing that's really important, as I mentioned, is to first make sure that you're not dealing with a scammer if you get a bill that you didn't expect. So how can people tell the difference between a legitimate debt collector and a criminal scammer? Well, this slide shows some red flags of a debt collection scam.
 
One is that they'll pressure the person to pay by an unusual method like money transfer or prepaid card. Scammers really like those payment methods because they might be harder to trace, and it can be really hard for people to get their money back. A scammer might falsely threaten someone with jail time. They might pose as a government official. They might say that they'll tell your family, friends, or employer that you owe this money. However, a debt collector is generally not allowed to tell other people about your debts without your permission. They can only ask people about your contact information or your whereabouts so that they can try to get in touch with you. So if they're threatening to reveal your debts to someone, that is a red flag. Also, you may not recognize the debt that the person is claiming you owe, and we have resources on our website to help people ask the right questions to make sure you really owe the debt. And any debt collector who contacts you saying that you owe payment on a debt is required by law to give you information about that debt. So they have to tell you the name of the creditor, the amount that's owed, and if you think you don't owe the debt or maybe it's not even your debt at all, you can tell the caller that you're going to dispute the debt. Then you can send a written request to the debt collector to get more information about the debt or to dispute it. And we have sample letters that you can use and adapt to send to the debt collector.
 
If someone calls asking for a sensitive personal financial information, like a bank account routing number, Social Security number, that's a huge red flag. Never provide anyone with your personal financial information unless you're sure that they're legitimate because scammers can use that to commit identity theft. 
 
It's also a red flag if you're getting calls at very inconvenient times because debt collectors cannot call you at unusual times or places. For example, if they're calling you at 2 a.m. or some other unreasonable time, you might be dealing with a scammer. 
 
Next slide, please. So if you're helping someone who's getting calls from debt collectors, but they don't think that they owe the money, like I mentioned, they can send a letter to ask for more information about the debt or they can send a letter to dispute the debt. And we do have those sample letters on our website, which you can look online. If you type in "not my debt" on our homepage, you'll find them. 
 
Next slide, please. You might also be helping someone who says that they found incorrect information in their credit report. Maybe there's a debt listed that they don't owe or for the incorrect amount of money. If that's the case, they can file a dispute with the company who sent the report in. They can also use the contact information provided on an adverse action notice if they received one. We have information on our website about how to dispute inaccurate information in credit reports. And we've got sample letters for this as well.
 
Next slide, please. As we just discussed, everyone has the right to dispute mistakes in their credit report for free. However, there are companies that may offer to repair credit for a price, and as outlined in a recent consumer advisory from the Consumer Financial Protection Bureau, a company that uses telemarketing to sell credit repair services has to meet certain requirements before they can charge for their services. And consumers have the right to see results before they pay. The company must achieve the results that were promised within the time frame that they stated, and the company has to give you a consumer report showing the results that was generated more than six months after the results were achieved to show that they did make the improvements that they promised to your credit. You can find more details in the consumer advisory on this on our website.
 
Next slide, please. We talked about debt collection scams a little bit earlier. So now I want to talk a little bit about debt relief or credit repair scams. We have articles about how to tell a credit repair scam from a reputable credit counselor. We have articles about the difference between what is a credit counselor and what is a debt settlement or debt relief company. So you can take a look at those. In terms of red flags for scams in this area, it's important to watch out for companies that want you to pay before they provide services or do any of the work. If they don't tell you your rights and they don't tell you what you can do yourself for free, for example, disputing errors in your credit report, that's a free legal right, again, available to you under the Fair Credit Reporting Act. So you don't need to pay someone to do it for you. If they're telling you to dispute everything, all the information in your credit report, even if you know a good amount of it is accurate, that's a red flag. It's also a red flag if companies are making promises that they can't keep. For example, they say we'll remove all the negative information from your credit report, even if that information is accurate and current. Unfortunately, no one can do this. So it would be a red flag if they were saying they could. And if they're claiming that they can guarantee a specific increase in your credit score, that would be a red flag as well. 
 
So credit repair companies are subject to a lot of different federal laws, including the Credit Repair Organizations Act. They're also often subject to the telemarketing sales rule, and both of those prevent them from using deceptive practices and from accepting up-front fees. And these laws really prevent a lot of deceptive practices by the credit repair organization. So you might have a right to sue a credit repair organization who's not following those laws.
 
And I know we're talking a lot about scams and bad practices, and I want to just remind you all that there is reliable and trustworthy help available. You just need to help people find it. Places like the CFPB website are great to start to get information about the problems that they're having.
 
Next slide, please. So we want people to know they can also reach out to the Medicare hotline if providers who accept Medicaid refuse to give care. So Medicare hotline is not just for Medicare only, but if they refuse to give care because of an unpaid bill, accurate or not, this is a great place to go.
 
You can also call the 1-800-MEDICARE hotline for information about other Medicare-related problems. This includes general questions someone might have as well as information about health plans, specific billing questions, questions about your claims, medical records, expenses. Sometimes people just need help logging into their Medicare account or they need a replacement card, but this is a great phone number to call for all of those different issues.
 
Next slide, please. To raise awareness about the debt collection, including nursing home debt collections, we have a handout that talks about consumer rights as well as some of the things to look for in nursing home admission contracts.
 
Next slide, please. We talked earlier about how consumers can file complaints with our agency about different financial products and services, and this slide shows how you can do that either on our website or by phone. And like Hector said, we track trends in the complaints that we receive, and we use that data to prioritize how to focus our policy work as well as our supervision and enforcement work. And we also use specific complaints to inform different enforcement, regulatory, and policy actions. So if you're tired of seeing a consumer financial problem coming up over and over again in your work or even in your personal life, consider submitting a complaint to us. And if you are helping someone else to submit a complaint, a client or a family member, particularly if that person doesn't use email, doesn't have an email address to help them submit a complaint online, it might be easier to call together with them and submit that complaint by phone.
 
Next slide, please. After you submit a complaint, you can check the status online, or you can also call in if you submitted it by phone. And we'll also send you email updates along the way if you included an email address so that you know where you are in the process and what comes next. And then after the company responds to your complaint, you can log on again to review the response, and then you can provide feedback to us about whether the company resolved your issue or not.
 
Next slide, please. Again, if you are helping someone to submit a complaint, it's really important to help them outline their thoughts and try to write out their complaint as clearly as possible, including anything that they already have done to try to communicate with the company or resolve the problem. And if they're supporting documentation like a medical bill that they received, they can upload a copy with their complaint if they are submitting online. You also have space to talk about what your ideal resolution would be, so you can help the person consider what steps they would like the company to take to make things right with them.
 
Next slide, please. We recently spoke with the Employee Benefits Security Administration at the Department of Labor, and they reminded us that they have benefits advisors who provide individualized assistance and information to people who have employer-sponsored health plans. So this includes Medicare Advantage plans and employee retirement plans that include health benefits. And the benefits advisors there can help in over 200 languages.
 
And I should have mentioned also that our complaint—if you phone in to file a complaint, we can help in many, many, many different languages as well.
 
Next slide. This one shows the ways that you can connect with the EBSA benefits advisors, either by phone or online. There's contact information here.
 
Next slide, please. Finally, to wrap us up for the day, if you haven't used it before, our Ask CFPB online resource has answers to a ton of financial questions. So if you have questions about some financial product or service, you might be able to find an answer here.
 
Next slide. This is our Office for Older Americans webpage, Consumerfinance.gov/olderamericans. We have tons of free resources there for older adults and caregivers, and if you look at the sidebar on that page, you can join our mailing list where we'll send you occasional alerts about new resources and other updates. 
 
So I want to thank you all so much again for joining us for today's session. Hector had to hop off, so he's not here for the Q&A portion, but I'm happy to answer questions. And then if there are things that are specifically for him or we don't have time to answer today, I can try to do my best to get back to you after the webinar if you want to send your email address privately to me in the chat. 
 
So let's see what all is in here.
 
>>Ken McDonnell: Kate, one thing that we had come through, a couple of people asked—you had some wonderful stats, but they weren't in the slide deck. Were they in the notes section, or could you create a separate one-pager with those stats? 
 
>>Ms. Kramer:  If the person can just pop in and say which stats they were—I'm guessing it might have been from—we had an internal study that we did with RAND under a contract where we were looking at the single respondents and the couples and married households and looking at how much they could cover. So I can pop that into the chat. It's actually on RAND's website.
 
And then I also mentioned some of the family caregiving documentation from AARP, and that may not have been on the slide either. So let me see if I can find that, and I'll pop it in the chat.
 
>>Mr. McDonnell:  Thank you, Kate.
 
>>Ms. Kramer:  So I'm trying to scroll through the chat, and, Ken, please feel free if there are other questions to ask them to me, because I'm like slowly trying to scroll through, but I see—
 
>>Mr. McDonnell: Well, there is other questions. Asked by Holly Rhodes [phonetic], if a bill is filed too late and the insurance does not pay, is the insured responsible? 
 
>>Ms. Kramer:  Okay. So I think you're asking if the provider bills, the insurer—too late for the insurer to pay. So that's actually the situation in the news article that Hector shared at the very beginning. There was a story of the Medicare beneficiary who got sent to collections for an unpaid bill because the provider didn't bill Medicare on time. They sent it 17 months, I think, after the surgery, and so Medicare denied it because they have to be filed within 12 months. And so there are lots of stories of this where people are billed for things that they don't owe because they should have been covered by Medicare or their insurer, because the provider maybe doesn't bill within the right amount of time or they would rather bill the person directly for whatever reason. But that is a bill that that gentleman in particular didn't owe. I think it's fact-dependent, but I think that's what you were asking.
 
>>Mr. McDonnell: We've got a question here. I don't know if you'd be able to answer it or if we'd have to go over to consumer response, but the question is, does the CFPB take the default position that if a person files a complaint, the person is correct and is being honest about the situation? It feels that the CFPB's basic assumption is that every complaint is 100 percent true and no one could possibly be at fault but the company involved.
 
>>Ms. Kramer:  That's a really interesting question. I actually read a lot of complaints, because part of my job is to see what's going on in lots of different areas, and since I get to see both the consumer's side from their complaint and also the company's response, if the company provided one, a lot of the time it seems like there is a miscommunication or maybe sometimes the consumer misunderstood something. So it's not necessarily that the person is, I guess, correct, because they may not understand something that happened, and then the company's response may clarify that for them. But we definitely take the complaints that people are filing very seriously, whether they fully understood the situation in the first place. If there's an issue with miscommunication, that's also a consumer problem. So I guess I would say there's not necessarily an assumption that every complaint is 100 percent true, but oftentimes if people are complaining, there's a pretty significant issue.
  
 >>Mr. McDonnell: Thank you, Kate. And related earlier about the question on if a bill is filed too late and insurance doesn't pay, a question coming in, also, if they file too late and denied, can they bill for the co-payment afterwards as well?
 
>>Ms. Kramer:  Honestly, I'm not sure of the answer to that question. I'm very sorry, but if you want to put your email address into the chat, I can follow up with you on that.
 
>>Mr. McDonnell:  Thank you, Kate. Another question. Are there any supports you can suggest for those who cannot pay their medical debt?
 
>>Ms. Kramer:  So some of the resources that we talked about in the resources section, like the health insurance counselors and others, might be able to help because the health insurance counselors can take a look at the person's full situation and see if they're eligible for some kind of financial assistance or other services that can help them with their medical costs. So depending on where they are and what they might qualify for, there might be support for them.

So it's a really good idea to contact the SHIPS, the State Health Insurance Assistance Programs, for some health insurance counseling. 
 
>>Mr. McDonnell:  Okay. So that's all the questions we have and all the time we have. We have three minutes till three. Also, if any of you could think of any other questions that pop into your mind afterwards, please send an email to OlderAmericans@cfpb.gov.
 
And with that, we'd like to conclude. Robin, would you conclude us?
 
>>Ms. Dixon-Jefferson: Okay. Thank you all for joining us this afternoon. Have a wonderful and safe rest of your week.
 
>>Ms. Kramer:  Thank you all so much and please reach out.

[End of recorded session.]
  
2