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Post: Are You Getting Billed For Medical Bills You’ve Already Paid Or Were Covered By Insurance? Here Are Three Ways You Can Fight Back



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Last year, I fought several pitched battles along multiple fronts with health providers and my insurer. I won all of them.

It’s no surprise that when you get older, you’ll need more medical care and will receive a lot of bills, some of which are in error. According to Kim Blanton, who blogs for The Center for Retirement Research at Boston College (CRRC), “The stories are harrowing. In complaints to the federal government, retirees describe the costly errors in medical billing that they struggle, often unsuccessfully, to straighten out.”

“The Consumer Financial Protection Bureau reports that unpaid medical bills for people over 65 amounted to $54 billion in 2020 – a 20% increase over 2019’s unpaid bills.”

“Too many of these unpaid bills were charged in error,” Blanton adds “demanding that retirees pay money they didn’t owe, the agency said. And the amount of unpaid bills they reported in surveys rose in 2020, even though older Americans had lower out-of-pocket expenses because they avoided going to the doctor during the first year of COVID.”

The one thing to keep in mind is that a providers’ first bill is not gospel. I’ve found that many try to collect before their claim even goes through insurance processing.

“The billing errors occur for all kinds of reasons,” Blanton adds, “from medical providers’ failure to run charges through an insurer to the more complex system of medical coding required for the health conditions that crop up as people age. Another problem is a lack of coordination between the federal Medicare and federal-state Medicaid programs. People with dual coverage make up 10 percent of the retirees reporting they have unpaid medical debt, even though, in most cases, they should be paying little or no out-of-pocket costs for their care.”

How do you protect yourself? Here are three strategies:

  • Have You Seen an Estimate of Benefits? Some providers may be slow or neglect to process your claims through your insurer. You need to have your insurer process the claim before you see or pay a final bill. Your insurer needs to send you an Estimate of Benefits telling you what they will cover.
  • What’s Your Out of Pocket? Every policy from private plans to Medicare has a set limit on your out—of-pocket expenses. That’s the first thing to know. When you get a bill, have you satisfied the deductible?
  • Know Your Appeal Rights. Every state gives you a process for appeal. Know what it is and follow through with all the documentation you need. Sometimes you are right and they are wrong.

On the last point, I know appeals work. I spent months appealing a $40,000 bill that my insurer said they wouldn’t cover. It was an ordeal, but I won by following their appeal process to the letter.

Here’s another resource for appealing medical bills. Remember, you don’t have to pay the first bill you see. Also work with your insurance company to see if the billing is correct.

Lora Helmin

Lora Helmin

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