07/28/2022 CFPB  Medical Debt Webinar Scheduled Time: 1:45pm3:45pm Captioner: Lana K. Crain >>> Good afternoon. I am Tracey Wade from the Bureau Events Management team. I will go over some logistics before we begin. Be aware this event is being recorded and will capture webcast images and voices of all speakers. The recording will be shared publicly by the bureau. A link to live closed captioning will be placed in the chat box. You can access the chat box by going to the lower right side of the Webex window. If you experience any issues with your audio, click on the audio button near the bottom right of your screen. The audio options are located within the circle button with three dots near the bottom of the Webex window. There, you will receive guidance on switching audio to your telephone. To manage the way you are viewing the speakers today and their slides, click on the layout button located near the top right of the Webex window. Please add your questions to the chat box at any time during this session. For technical support during this webinar, use the chat box to send a message to the host and I will provide assistance. Now, I will turn it over to Kenneth McDonnell from the Office of Consumer Education. >> Thank you tracey all and thank you for attending today’s webinar on medical debt. As many of you are aware medical billing and collections can hurt people's finances when they are struggling with a health related issue. The Consumer Financial Protection Bureau is taking action to address this issue. In this webinar CFPB experts will discuss the following We will discuss the following, findings from recent CFPB report, Medical Debt Burden in the United States, policy changes regarding medical debt credit reporting, paid and low balance medical collections on consumer credit reports. Hospitals required financial assistance program and consumer complaints and medical debt and credit reporting. We will begin with our first speaker, Aarthi Kannan, who will present findings from our recent Medical Debt Burden in the United States. >>> Thank you Ken hello, everyone. My name is Aarthi in the Director's Financial Analyst program in the CFPB it a rotational program, currently in the Office of Research along with some of the other presenters you will hear from today. Last year, I was in our Office of Markets where I worked on medical debt issues for the Bureau, specifically in consumer reporting marketing and I focused on how medical debt affected credit reporting, background screening and I helped the debt collections markets team author the report I will be talking about with you all, Medical Debt Burden in the United States. My presentations today will focus on findings from this recent report as well as forthcoming policy changes regarding medical debt credit reporting announced by the nationwide consumer reporting agencies. >> So this report, medical debt burden in the United States, used a variety of previous bureau research on medical debt and new findings from the Bureau’s consumer panel survey and various other survey data and external research. The report includes four sections, Medical Debt Landscape, Adverse Impact, Covid 19, and finally and legislative and regulatory developments. This report used the CFPB's Consumer Credit Panel to estimate the scale of medical debt in collections on credit reports. The CCP of CFPB has a 1 in 48 representative sample of U.S. consumers. Some facts you will see on the slide we found from the CCP, $88 billion in medical debt in collections, as of 2021, 58% of all thirdparty debt collection trade lines were for medical debt, making medical debt the most common debt collection trade line. The next most common debt collections trade line was telecommunications debts. At only 15% of trade lines. 58% of medical debts 15% of telecommunications. It is the most common debt function trade line by far. We also found that the median balance on medical collection trade lines was $310. And 62% of medical debt collections were under $490. This map that you will see on the righthand side shows the state level prevalence of medical debt on consumer credit reports as of 2020. As the map illustrates, there are geographic differences in the prevalence of medical debt in collections by state. You will see the south has the highest percentage of individuals with medical debt in collections. A 2021 study published in JAMA found that 23.8% of the population in the south had medical debt in collections, compared to only 10.8% of the population in the northeast. The south not only has a higher prevalence of medical debt and collection but also a higher balance amount in medical debt in collections. Debt balances were higher in the south. The mean balance was $616 in the south compared to only $167 in the northeast. Diving a little further into the medical debt balance amounts we observed in our consumer credit panel, as this graph shows, many medical collections on consumer credit reports are low dollar balances. In 2020, the median medical collection was $310 and 62% of medical debt collections were under $490. So you will see a lot of these are concentrated on the lefthand side. However it is important to note that many people with medical debt have more than one collection on their credit report. As of December 2020, the median person with at least one collection owed $797 in medical debt. Some are captured in surveys. In a 2017 census survey, households with medical debt said they owed $2,000 which is higher than our estimate of $797. Since not all are medical collections are furnished to consumer reporting companies. The total amount of medical debt in collections in the U.S. is higher than CFPB's $88 billion estimate. As I mentioned a couple of slides as, medical debt is more prevalent in the southern United States. We also see that other demographic populations face higher rates of medical debt. Black and Hispanic people have more than white and Asian counterparts. Black and Hispanic people are less likely to be insured. In general uninsured people tend to have larger medical debts than insured people, partially because they are often charged significantly higher prices than insured patients. 62% of those with medical debt say that the person who incurred the bills were covered with health insurance. We see that young adults aged 2537 and low-income individuals of all races and ethnicities are more likely to have medical debt. Additional people with disabilities also tend to have higher than average levels of medical debt and older adults and veterans are heavily impacted by medical debt. The difference in insurance averages might contribute to these disparities. Stepping back a bit, I just want to add that the cost of medical care can vary widely. Medical bill amounts can be unpredictable and can often vary widely based on provider and patient characteristics uninsured and out network patients are often charged prices that are higher, even though they may have little ability to pay. Prices charged to uninsured and out network patients sometimes significantly exceed providers’ cost. Markups are especially high for emergency care and forprofit investor-owned hospitals can charge higher average markets. For many of these reasons, we found that medical debt can have extreme adverse impact to consumers, including impact to one's mental, physical, and financial health. A little more about the financial health impacts. People with medical debt report much lower levels of financial wellbeing and these adverse financial impacts come in a few forms. One form is credit scores. Past due medical debt reported to a consumer reporting company can appear on a person's credit report and lower their credit scores, which might reduce their access to credit and make it harder to find a home or a job. As we mentioned earlier, medical debt is by far the most common collection on credit reports. However, medical collections are less predictive of future repayment problems than are nonmedical collections and certain newer credit models take this into account. But some widely used models still weight medical and nonmedical collections equally. Which means those populations I mentioned on the last slide are more likely to face medical debt might be more heavily outdated by outdated credit models. Some other financial impacts of medical debt include bankruptcy and costly collections litigation. There are also physical and mental health impacts. We see health care avoidance. 46% of people with medical debt purposely avoided care. This can be problematic if preventative or early care is avoided due to cost and if conditions spiral into dangerous and more costly health issues. We also see that people with medical debt have an increased risk of chronic pain and early mortality. We see that 4 in 10 people say they are more afraid of medical debt than of serious illness. This is very distressing and medical debt can take a distressing toll in many individuals lives. We see people with medical debt can have increased instances of depression, anxiety and unfortunately suicide. Many of these adverse impacts have been exacerbated due to the Covid 19 pandemic. 50% of all people affected by Covid 19related hardships had medical bills or debts problems in the last year, particularly uninsured patients might avoid Covid 19 testing and care out of fear of medical debt, contributing to further physical health problems. People of color are also more vulnerable to Covid 19 related medical debt and 72% of sure insurers have stopped waving deductible, co-payment and co-insurance costs for Covidrelated care. That concludes the portion about findings from our recent report. I will talk a little bit now about the changes to medical debt credit reporting policies that were announced by the nationwide consumer reporting agencies, Experian, Equifax and TransUnion. In March 2022, shortly after the release of the medical debt reports, the three NCRAs, Experian, Equifax and TransUnion, announced they will remove certain medical collections from people's credit reports. The three NCRAs announced they will one extend the waiting period before furnishing medical debt from 180 days to one year. This will go into effect shortly. Secondly, they announced they would remove medical debts paid by consumers, also effective this month. And finally, they announced they will stop reporting medical debts under $500, will which go into effect sometime early in 2023. To that last point, we have found using the CPP that 62% of medical debts collections were under $490. Some changes will be made on the NCRA's when compiling consumers reports and others of the changes will be made when directed by the furnishers providing information to the NCRA’s. The Office of Markets at the CFPB, both the debt collections and the consumer reporting markets, are very interested in following how these changes will actually be implemented. And Lucas Nathe our next presenter will be speaking more about Bureau findings released yesterday on the impacts of these policy changes on medical and consumer credit reports. First, we have a few minutes for questions about my presentation and we will also have more time for questions at the end after each presenter’s time and altogether at the very end. For now, are there any questions? >> Yes, Aarthi. We do have a question here from Sonia. She is asking, what will happen with existing medical debt and credit reports which are under $500? >> Yes. So the Office of Markets attended some through industry events where they discussed what will happen to retroactively to existing debts that are below $500. I don't believe we have confirmation on what will happen to those collections, but I believe that more information will be released shortly. One of our other presenters may be able to speak to this shortly coming up. I do not have an answer for that. Thank you for your question. >> Thank you. We've got a couple more that are coming through here. From Anita Beasley, will the PowerPoint slides be available? Yes, they will be. From Brittany, is there any particular reason why we see higher medical debt over the northern and Northeastern states? >> Yes. We have been in contact with medical providers, and policymakers in these states. There are a lot of reasons contributing to why these levels are different. A lot of it has to do with existing laws that determine what providers can charge in different states. Since these vary state by state, in the south, costs for medical services can be higher we also see a correlation between where Medicaid was expanded and insurance coverage in these states contributing to higher amounts of medical debt. >> Thank you. We have another question here from Edris Tucker. Is it possible to make hospital sponsorship for hospital bills automatic for nonprofit hospitals so they can give away more than 1% of revenue? >> Unfortunately, I am not able to speak to this question. This might be a question that would be directed to the folks in the debt collections market, who will be speaking more with hospitals and hospital treatment organizations. That is a great question. Unfortunately, I can't answer it. >> No worries. Thank you very much. We have another from Brittany Fox. Is there any particular reason why we see  sorry. We did that. These are coming in rather fast. Another one here from Dawn Hall. What happens with medical debt when the consumers have proof that has been paid, but it is still showing up on their credit report? >> Previously, before this change was announced by the NCRAs, it was only medical debts that were paid by insurance that would be able to be removed from credit reports. Now, we have this changeup that's allowing all paid medical debts to be removed. If you have a paid collection that is still showing up on your consumer report, we recommend that you file a dispute with your with the NCRA and dispute that portion on your credit report and you can see that is changed and has now been paid off. Those should be removed. Again, someone had asked about automatic and retroactive changes. That should be removed as long as you are able to provide that. >> We have another from Shaunte Gray. She wishes to add into Sonya’s earlier question, is there a process of removing those medical debts from the credit report if we find those debts still exist on the credit? >> Yes. I think similarly to my response to Dawn about debt you believe should have been removed through this process and has not been removed and also submit contact the Consumer Reporting Agency on whose report you found this debt. Send them this information. They should be in contact with you about the possibility of removing that. I would like to add, if you are still having troubles having that removed after you made attempts to contact the reporting agency, you can always submit a complaint to the consumer financial protection bureau through consumerfinance.gov. Another question from Cindy. I often hear health care costs are the number one attribute to to a person's filing for bankruptcy. How does this data relate to that statement? Is it true? >> So in this report, medical debt burden in the United States, we actually dive quite a bit further into the financial impact, impacts of medical debt. We do have a few paragraphs detailing how it plays a role in bankruptcy. We do see that medical debts can be a cause for folks filing for bankruptcy. We do talk more about that in our report. I definitely encourage you to check out those paragraphs. We definitely see a lot of these financial impacts tie together with one another and a lot of people who do file for bankruptcy. >> Thank you. We have another question here. You have generated a lot of questions, Aarthi. Celina Landford is asking, Will paid medical debt be removed automatically or will a person need to manually call and request it? >> I think this is similar to Dawn’s earlier question. I am trying to read the full question. I believe that that should be removed for you. We find there are errors in credit reports, if someone finds there is an error and debt was paid, it should be removed. If you contracted the specific credit agencies where you found that debt. Shaunte Gray is asking, is there a law we can reference when we need to file disputes. >> If you are discussing the dispute as related to the new NCRA announcement, you can refer to the announcement. Otherwise if you need to file a dispute about anything on your consumer report, the CFPB website has information on the Fair Credit Reporting Act. What I would recommend, determine what exactly you are disputing. Is it a medical debt? Is it an inaccurate payment or repayment status? If you go to the CFPB website and look up, how do I dispute something on my credit report, we have a lot of information. You can see which specific item you would want to reference. Specifically, for medical credit reporting, the main sort of actions you will want to be familiar with are the fair credit reporting act, NCAP, the national consumer assistance plan, which is what has dictated a lot of these changes previously. You will also find more information about that in our report and finally this recent NCRA changes. >> Thank you, Aarthi. I am going to have to cut off questions after that one. We are capturing these questions and will get back to you all for those questions we were not able to get to. We would like to continue on with our program. Thank you. >> Sure. I will go ahead and turn it over to Lucas Nathe who is in the bureau to talk more about medical collections on consumer credit. >> Hello, everyone, my name is Lucas Nathe, I am currently a research analyst in the Office of Research. In a report published yesterday, Ryan Sandler, myself and the rest of the team investigate medical collections that likely to be removed from consumer credit reports in the next year due to the policy changes we have discussed. As Aarthi mentioned, March 18, 2022, the national credit reporting companies said they would change the way medical collections were reported. Specifically the companies announced starting July 1st, the time before unpaid collections appear on consumer credit reports will be increased from 180 days to one year and paid medical will no longer appear on reports at all. They also announced that beginning sometime in 2023, medical collections with balances below the threshold of at least $500 will no longer appear on consumer credit reports. These changes have the potential to reduce the amount of medical debt reported on consumer credit reports and to benefit some consumers. Here is the usual disclaimer. It will apply to this presentation as well. In the report, we hope to find a baseline for what the effect of the policy change might be. The report contained three primary sections, first, the characteristics of consumers with reported medical collections. Second, the persistence of medical collections on credit reports and lastly which medical collections are likely to be removed. We will begin by getting a sense of what consumers medical collections look like as well as what other types of debt they were holding before that medical collection was add today their report. The first column describes the medical collections trade lines and the second one focuses on collections with an initial balance of less than $500. The last column is limited to collection that is were eventually reported as paid. The collections in the second and third columns are those that would likely be removed in the coming year due to the reporting policy change. Although, almost twothirds of medical collections trade lines have an initial balance less than $500, a very small percentage, 2 or .6% are ever reported paid. Consumers with medical collection trade lines typically have lower scores even before the medical collection appears with an average score of 573 in the quarter before the collection appeared as compared to the national average of 714. About 75% of medical collections are associated with consumers who already had at least one medical collection and 53% are associated with  medical collections are associated with consumers who had nonmedical collections. Towards the bottom, you can see here scores declined between 12 points and 17 points on average in the quarter before the medical collection appears. Next, we turn to the persistence of medical collections on credit reports. The impact of medical debt on consumer credit reports depends in part on how long a collections trade line continues to be appear on a record. Less than 20% of medical collections trade lines are still on consumer credit reports at the end of four years. This figure shows the share of medical collections that remain on consumer credit reports since they were initially reported separately for initial balances above and below $500. One clear pattern sticks out, and that is that low balance medical collections remain on credit reports significantly longer than higher balance medical collections. Both balance amount categories, the share of medical collections trade lines that are still reported quickly drop in the first few months after the initial report. Only about threequarters of the collections above $500 are still reported 180 days later. As a result of the medical collections reporting change, some collections that drop off quickly may never appear at all, since this will extend the grace period up to one year. Moving on, finally, we focus on medical collections that are going to be removed in the next year. This figure shows the share of consumers with medical collections in green, the share of consumers with all collections less than $500 or paid in the orange and the share that has unpaid medical collections greater than $500 in blue. You can see that in 2017, almost 20% of consumers had at least one medical collections trade line on their report and that share has been falling in recent years. At the end of our sample, in March 2022, 14% of consumers, almost 1 in 7, had at least one medical collection on their credit report. Over time, the share of consumers who have only paid low balance medical collections has fallen as well while the share who have at least one unpaid collection of more than $500 has stayed relatively constant. In March 2022, about half of consumers with medical collections on their report would have no medical collection if the reporting changeup were in effect. This would leave about 7% of consumers overall with at least one medical collections trade line as indicated by the blue line. As previously discussed, there is heterogeneity across different states when it comes to medical debt. We will look at the geographic distribution of which medical collections will likely be removed Consumers in West Virginia have the greatest share of medical collections removed. More than 80% of medical collections associated with consumers in West Virginia are likely to be removed. These trade lines represent more than 30% of the total balance of medical collections in that state. West Virginia has the greatest share of consumers with at least one medical collection trade line and the second highest number of medical collection trade lines per capita, which explains this outlier status. Finally, we examine how low balance and paid medical collections are distributed across census track demographics. The baseline in the first column reports the share of consumers in the first CCP who reside in census tracts in each category. The second column reports the distribution of consumers with at least one medical collection trade line across the categories and the third column represents distribution of consumers who will likely have one such trade line removed and the last column reports the distribution of consumers who will likely have all of their medical collection trade lines removed by the reporting change. Consumers residing in the majority black and Hispanic census tracks are overrepresented by those with medical collections trade lines relative to their share of consumers those overall. While consumers in majority black census tracks comprise 6.2 percent of consumers in the CCP, they make up 10.5% of consumers with medical collections. Now, turning to the lower part of the table, we can see that reported medical collections are concentrated disproportionately among consummers that reside in census tracks with lower median income. While 13% of consumers in the CCP reside in a census track with median income below $40,000, more than 21% of consumers with medical collections reside in those census tracks. At the same time, consumers with medical collections who will be removed following the changeup are slightly more likely to reside in high income census tracks when compared to all consumers that have medical collections as indicated by the fourth and second column toward the bottom. This report showed that a substantial share of medical collections currently reported on consumer medical reports likely qualify to be removed under the change recently announced by the credit reporting agencies. The Bureau will continue to analyze how medical reporting changes may affect consumers. You can find the full report at the link here. Now, I'll take some time to address some questions before turning it over to my colleague, Eric Wilson, who will discuss hospitals acquired financial is assistance and its relation to medical debt. >> We have a question from Idris Tucker. Because FHA mortgages don't consider and conventional mortgages look over at medical debt over $2,000 and business loans may also not consider medical debt, is it likely that these changes will affect a greater proportion of medical debt collected overall? >> I'm just rereading the question to make sure I'm getting locked in. It is a bit cut off. Is it likely these changes will affect a greater proportion of medical debt  what's the rest of the question? >> Collected overall. >> I'm not as familiar with FHA and mortgages and the interaction between medical debt and underwriting for those loans. I would be happy to ask someone who knows who are and get back to you about that question. >> Thank, Lucas. We have no others. We can turn on over to Eric. >> Thank you. >> Thank you all. So my name is Eric Wilson. I am also a research analyst in the office of Research. My general research focus is on financial wellbeing and things that affect financial wellbeing. So naturally the financial impact of medical care is a big topic in my life. So Lucas and Aarthi discussed the prevalence of medical collections, who experiences medical debt and how medical debt and the possibility of medical debt affects consumers. We have also talked about some of the big changes to how medical collections are reported in credit records and what those changes might mean. Now, we're going to move upstream for medical debt and collection to a topic related more to the affordability of health care itself, which is the financial assistance programs that hospitals are required to create for patients who may be unable to manage the costs of the care that they receive. To complement the materials that Lucas and Aarthi already discussed, we have also released a background brief on our website of about these programs, which you may know more about the common name, Charity Care. That's not a term I'll be using here. In the brief, we use the term Required Financial Assistance instead of Charity Care, because it reflects the idea this is actually mandatory thing that hospitals are legally obligated to do. I'll start with some background on what these Required Financial Assistance programs are. Then, I'll move into the question who is eligible for these programs followed by the slightly different question of who actually receives financial assistance. At the top, data and research on these financial assistance programs proved fairly scarce. The central conclusion that we drew in the brief that we recently released is that more research is required to understand how people access financial assistance and the impact it has on their finances. What is Required Financial Assistance? Financial Assistance is a community benefit, medical care that is provided for free or at a discount to patients who cannot afford to pay for the care that they receive. This provision of financial assistance is mandatory for nonprofit hospitals in order to maintain the tax and other financial benefits that come with nonprofit status. Federal law requires nonprofit hospital to communicate their policies for financial assistance to their patience, specifically under the affordable care act, nonprofit hospitals must widely publicize their financial assistance policies and provide paper copy of the summary of the policy as part of their patient intake or discharge process. They must display their policies in public spaces at the hospital itself and include website links and contact information about the financial program on their billing statements. Some states actually have additional requirements, for example, in addition to providing the policy in writing, Washington State requires that hospitals inform their patients verbally about the policy itself and Washington State also requires that hospitals prior to attempting to collect on past due medical bills, that those hospitals actually screen patients for eligibility with their financial assistance programs. Who are these eligible folks? Federal law actually doesn't specify the criteria that hospitals are supposed to use to determine who is eligible for financial assistance. State law, however, does in many instances if those requirements vary widely. Most of them, however, are based on the federal poverty level. So, for example, this is a screen shot of New Jersey's income criteria for eligibility for financial assistance programs in the state of New Jersey. What you can see is that for people making less than two times the federal poverty level care at a nonprofit hospital can essentially be entirely covered by financial assistance. New Jersey has some additional requirements on top of this, which include asset requirements but what this means is that essentially in New Jersey, a person and a family of four making in 2022 less than $55,000 per year, could be eligible to have their hospital bills largely taken care of in many circumstances. This income increase in New Jersey, that care is still discounted until income actually exceeds three times the federal poverty level. Other states have different criteria. Washington State, for example, the threshold for free care is only 100% of the federal poverty level. Discounted care phases out at 200%, rather than the 300% level that you see in New Jersey. Eligibility does not necessarily imply actual receipt of financial assistance. To the question of who actually receives financial assistance, the answer is that there isn't much evidence available about that question but what does exist suggests that the people  not all people who are eligible actually do receive it. One of the studies that we discussed in the brief comes from 2015 and found that only 44% of all hospitals reported actually notifying patients of their eligibility for financial assistance before initiating a collection on a past due bill. That study actually used information from 2012 before the full implementation of the Affordable Care Act requirements. It is hard to say where things are now. We do have some anecdotal information from litigation. There is an ongoing lawsuit from the Washington State Attorney General alleging that several hospitals failed to notify patients of their eligibility and pressured patients that were eligible for financial assistance to pay their bills anyway. Among those who actually do receive financial assistance, evidence is also scarce but what we do have suggests that there is a strong gender imbalance starting from New Jersey in the early 2000s found that women were twice as common as men among recipients of financial assistance. That about does it for my bit of the webinar. You can find the full brief on the research hub section of consumerfinance.gov. In the brief, we go into more detail, including information on funding mechanisms for financial assistance programs as well as policies that are improving the regional financial assistance program. We expect to release more research on this as well as in other areas that where the health system actually has an effect on consumers' finances. For now, I will take some questions and then flip it back over to Nneka Lawson, who will discuss some of what we hear from consumers on medical debt and medical collections. Questions? >> We have a question from Idris Tucker. Will this financial assistance apply to rehab care? We found a local addiction center that would wave 75% of the cost if clients returned but only 5% of the clients do. They end up with collections for this amount that might have been free. >> Gotcha. So, as I understand it, the sort of federal mandate for financial assistance programs and these state programs applies specifically to nonprofit hospitals. So if that care occurred within the context of a nonprofit hospital and was provided in an arrangement where the nonprofit hospital was actually responsible for the care, then that type of assistance might, indeed, apply. It very much depends upon the status of the actual institution providing the care. >> He was also asking a followup. He noted that removing time limits for care that would have been covered by the hospital sponsorship, if applied for. Some systems have eight to nine months’ time to apply and then those debts could be free from collections. >> Gotcha. Time limits, it sounds like, may be a part of some hospitals payment policies. I don't think that there is necessarily a requirement for that particular thing. I don't think the federal law that we have examined for this particular brief goes into the removal or the extension of time limits. If those time limits do exist and to the extent that they do, that's a relevant piece of information for consumers who may be eligible for financial assistance, generally speaking. >> We have a question from Virginia Valenzuela related to time limits. Does the financial assistance ever apply to debts retroactively? >> That is an interesting question. I think in some states, again, I think in Washington State, the hospitals are required to actually check to see if people who owe past due medical bills are eligible for their financial assistance programs before sending those bills to collections. In that instance, if you would consider that to be applying retroactively, then, yes, that's the main thing that I can think of that we talk about in the report. That might speak to that particular question. >> Thank you. We have no more questions, Eric. Thank you very much. >> Sure thing. That does it for me. I will send it over to Nneka right now. >> Thank you, Eric. My name is Nneka Lawson. I work in the Bureau Office of Consumer Response. What is it exactly the Office of Consumer Response do? It is responsible for hearing directly from the public through consumer complaints. We use complaints to inform a variety of the bureau's activity including supervisory, enforcement, rulewriting and educational efforts. Additionally, complaints are used to monitor the financial marketplace. Today, I will be briefly discussing a recent report that we published analyzing medical billing and collection issues that consumers describe in their complaint. Now, before we jump into the findings, I want to briefly walk you through the complaint process so that you can better understand how we handle complaints and what information is forming the basis report. I am having some technical difficulties. Give me a second. Before we jump into the findings of the report, I want to walk you briefly through the complaint process so you can better understand how we handle the complaints and what information forms the basis of the report. Handling consumer complaints is one of the six numerated functions listed in the Dodd/Frank act. We have complaints across several consumer financial products and services. At our level, the bureau accepts complaints through three channels, online, over the phone and through the mail. We then send you to review and respond. We publish select information in our public consumer complaint data bait. The consumer can also provide feedback after they receive the response. Finally, we analyze the information and report out on it from time to time. In 2022, we are currently on pace to handle more than 1 million complaints. It is approximately a 15% increase from complaints handled 2021. Now, this past April, we published a Complaint Bulletin that explores the topic of medical billing and collection issues. This report is available on the bureau's website and it is the report that I will be discussing today. Now, when a complaint is submitted, complaints involving medical billing are often submitted in one of two categories, debt collection and consumer or credit reporting. Complaints in the debt collection category are about ongoing efforts to collect an alleged outstanding medical bills, whereas complaints in the consumer or credit reporting category are often about ongoing efforts as well as information appearing on consumer credit reports that they state are inaccurate. Now, the most common issue in debt collection and across all types of debts is the issue that attempts, this issue of attempts to collect a debt not owed. This issue makes up nearly half of medical debt collection complaints. I see it in the charts. Complaint volume has increased in recent years. Notably, complaint volume about attempts to collect debt not owed increased 31% in 2021 compared to 2018. In these complaints, consumers provided varying reasons for why they thought the medical debt the collector was trying to collect was not owed. For example, consumers reported that they already paid the debt. Some consumers reported that their insurance companies remitted payment. Other consumers reported that the medical care was covered by compensation. They stated they learned of an outstanding medical bill when they were contacted by a thirdparty collection agency. So they promptly paid the debt and yet continued to be contacted by that said debt. Even service members, some service members reported they were contacted by thirdparty collectors for medical debts covered by tricare or other government sponsored insurance programs. Our colleagues in the office of service member affairs recently published their annual report. On that report, they further explored the issues that the military members, veterans and their families are experiencing with medical debt. That report is also available on our website. Now, in recent years, we have also seen an increase in complaints related to written notifications about debt. In complaints about medical debt collection, nearly a third are related to the written notification about the debt. As shown here, as the percentage share of each debt type, this issue is most common for medical debt. Consumers sometimes reported that collection notices did not contain sufficient information to identify and verify the alleged debt. For example, consumers stated, often stated that they were not familiar with the provider listed in the written notice. Now, this can happen with the name of the health care provider list on the notice is different from the name of the professional or professionals who provided treatment. As is often the case when a provider is part of a larger medical group. This can also happen when the notice comes from a thirdparty debt collector that the consumer has never heard of or when there is simply not enough information on notice to identify the debt. In other cases, consumers reported that collection notices contained large amounts of personal medical information, such as information related to personal medical procedures, tests and medications that the consumer found upsetting or alarming. Now, in consumer reporting complaints to the bureau, consumers often stated they were never contacted about medical bills or they were reported to the credit reporting agency. Consumers often stated they only became aware of a medical bill when performing a routine review of their edit reports or while in the process applying for credit, such as applying for a mortgage. Oftentimes, those bills are old and small. In some instances, consumers become so frustrated trying to resolve questions about the alleged debts, even though they feel they don't owe these debts, they pay the debt collector just to make the collection efforts stop and to increase their credit score. With the announcement of medical debt furnishing we will be monitoring complaints to assess whether these problems will be alleviated. In response to consumer complaints, companies frequently close the account and discontinue their efforts these actions raise concerns about the accuracy of information being furnished to the credit reporting companies. As I mentioned earlier, we make complaint information available to the public so analysts, researchers and others can utilize this data to inform their own efforts. You can access this information by visiting our website at consumerfinance.gov. Finally, if you are working with a consumer or if you, personally, have an issue about a consumer financial product or service, you can submit your complaints to us online, over the phone or by mail. Our online form is available 24 hours a day and the most efficient methodt for complaints. It only takes about 710 minutes to complete the online submission form. If you prefer to submit a complaint over the phone or if English is not your primary language, don't worry about it. We have got you covered. You can call our 1800 number and speak with a representative. Our representatives are able to accept complaints in 180 languages and it can also provide status updates or answers to common questions. With that, I'll turn it back to Ken. Thank you for having me. >> Thank you, Nneka. We have a question from Idris Tucker. He would like you to repeat again about closed accounts. He said, I have often seen closed medical debts and wonder what that means when a balance is still reported. >> Let me just scroll back to the question. So this does happen from time to time. Even just as we are all consumers regardless of what we do for a living. I know there are times when we have paid a debt and we still see it reported on credit report and we have to go back and chase the service provider and say, hey, are you paid this? Why is this still being reported. One of the things we always say in the Bureau is to please submit a complaint, if you have already tried working with the service provider and they are being difficult about it go online go to our website consumerfinance.gov and submit a complaint. And what we'll do is route the complaint over to the company in question and, you know, while you are submitting the complaint, we also urge that consumers submit as much supporting documentation as possible. I'm a firm believer that you can't argue with facts. If you can showcase this debt was already paid, I don't know why it is still being reported, we have seen a lot of instances of this happening in the past. For the most part, companies are generally very kind about their, because mistakes happen. They will review the information submitted and the complaint and some companies will come back and say, you are absolutely right, we made a mistake on this. We will go ahead and notify this debt and reach out on behalf of you to the credit reporting agency and get them to take off whatever is being reported on your credit report. >> Thank you, we have another question from Vanessa Reynolds. Do hospitals and medical communities have a standard or required procedures to follow for collecting and reporting medical collections? >> I'm not 100% sure about the answer to that question. I'm willing to take it back as an action item or if any of my colleagues on the line happen to know the answer, I welcome you to respond. I'm not 100% sure about that. I'm willing to take it back and find way to send you a response. >> Okay. Thank you. We have a question here from Mack Ritter. He said, we have seen many consumers who have disputed wrongfully reported medical collections, for example, a bill covered by insurance, only for the account to say on the report with a note stating, account disputed, customer disagrees with findings. Are there other steps aside from submitting a complaint to take to remove the account? >> I'm still a firm believer to first of all submit the complaint. It is still okay to work behind the scenes with the service provider to see if there is way for them to take it off. Submit the complaint and it gets rerouted. I don't think it hurts reaching out to the reporting agencies as well. Ideally, you want the service provider, the original service provider to be able to review your complaint, and rule in your favor and go back to the reporting agency on your behalf and work with them to take it off. I don't think being aggressive hurts. I think it also helps if you work behind the scenes, while you submit the complaint and let that process continue, still go behind the scenes and see if maybe you can call someone and maybe through facetime and let them know, hey, this is what's happening. This is inaccurate and I think once again provide supporting the documentation as much as possible if you are able to present supporting documentation to showcase or bolster your argument. Starting with submitting the complaint and then maybe doing some additional things behind the scenes where you are contracting different reps from different companies to see if they can help you resolve the issue. >> Thank you, Nneka. We have a question from Brittany Fox. I have always been told if you have a medical debt, to contact the original provider and pay them, rather than pay the third party. Does it make a difference? >> I mean, I think it always helps to go straight to the source. I know in this day and age, companies aren't so in connected. Go straight to the source and give them, you know, the background and overview of what's happening. You know, I think in some cases, they will be able to kind of rectify the issue on their own. If you are having issues, realize, okay, this isn't 100% helpful. Once again it doesn't hurt to go back to the third party and document your conversation or the findings from the initial conversation with the first provider and just say, hey, I just talked to them. This is what they are saying. I just want to make sure they are all on the same page. Get them to be in alignment with one another so you can get the favorable decision that would work in your favor. >> Thank you very much, Nneka. We have a question here that could be sent to Eric. Hold on. Let me get to it. Eric, do hospitals and medical communities have standard procedures to follow for collecting and reporting a medical collections? >> Yes, I can't speak directly to all of the possible procedures for collecting and reporting medical collections. I can tell you that some states, again, Washington State as the example I have talked about before, do require hospitals to check if their patients are eligible for financial assistance before putting a past due bill out for collections. I suspect it may be possible, at least either Lucas or Aarthi, may have more to say on that particular question. I will let them speak for themselves. >> I just want to add one last thing. This is Nneka. If you are ever in a position where you tried every option available to you and you are still not making headway, we encourage you, hire an attorney to work in your favor. Sometimes litigation does help. We are not saying that should be the final resolution. There are some instances where it might work in your favor to look into hiring an attorney or speaking with an attorney for advice. >> Thank you very much. We do have a few other questions here I would like to pose to our panelists. One second here. Lucas, we have a question for you. Will removed medical debt only be with the three major credit reporting bureaus? In other words, is it possible they will still show up on a LexisNexis report? >> Thanks. I'm not very familiar with Lexsis Xexis. As it relates to the three major credit reporting bureaus and something that Aarthi and I have mentioned, not all medical debt is reported to all three bureaus. Unlike more mainstream consumer credit markets where you could reliably know that your credit card or auto loan will be reported to all three bureaus, that's not as much the case when it comes to medical debt. When it comes to removing medical debt, I am not sure about LexisNexis, but I think it is not as widely reported across all three. If you see it fall off of one, you might have greater odds of it being removed from all of your credit reports. I hope that helped. >> I want to add on to that. If you find that a debt is reported directly to LexisNexis, then if it falls under the changes the three major credit reports are doing, you wouldn't be able to use that as a reason to dispute it on your LexisNexis report. However, if it is inaccurate, if it has been paid, you can still try and submit that complaint or submit it through the CFPB. The policies recently announced on March 18th, I think, apply only to the three credit bureaus. >> We're running out of time here. I would like to be able to close this out. Again, for everyone who we didn't get specifically to your question, we will keep track of these, and we will be able to come back to some of these questions and try to reach out to you individually with answers or at least guidance to help you find answers tower questions. Again, I would like to thank you for your time, for coming to attend our webinar. I would like to remind all of you that our next webinar from the FinEx team will be coming out on August 18th from 3:00 to 4:00pm EST, this will be Financial Aid 101. The Consumer Financial Protection Bureau will be joined by the U.S. Department of Education to explore financial aid 101 and share resources to help students and educators create and pay for college. Again, thank you so much for your time. We greatly appreciate all your support and effort and look forward to working more in the future with you. Again, Tracey, if we can close out the webinar. Thank you very much. [ The webinar concluded at 3:05 p.m. ]