Two years. That’s how long Donna Domingo has been fighting with her insurance company over a medical expense.
A diabetic, Domingo needs an insulin pump, which the insurance company considers a prescription medication, not a piece of medical equipment. That makes her share of the cost nearly $500 for each three-month supply.
“There’s no drug in it. It’s a device,” says Domingo, 62, who worked in the pharmaceutical industry for 27 years. “How can you bill me for a medical device under a prescription program?”
Disabled and living on Social Security, she says she had to cut into the rest of her household budget to keep paying these bills.
“How am I supposed to afford this? I’m taking it out of food money,” says Domingo, who lives in Port Jervis, New York.
This kind of frustration is becoming much more widespread, leaving 7 percent of Americans over 65, or nearly 4 million of them, with nearly $54 billion worth of unpaid medical bills collectively — even though almost all have Medicare and nearly half pay for a second layer of private insurance.
That was up 20 percent from 2019 to 2020, the most recent period for which the figure is reliably available and a time when older adults actually made fewer doctor visits because of COVID-19. It comes to more than a quarter of what the independent policy research organization KFF estimates is $195 billion in medical debt faced by U.S. adults of all ages.
The average individual amount purportedly owed by over-65s with unpaid medical bills also increased, to $13,800, according to the federal Consumer Financial Protection Bureau, or CFPB.
Billing errors a big cause
Although even Domingo concedes that complex Medicare reimbursement rules mean that the insurance company in her case may be right, the CFPB finds “a high likelihood” that many bills like these are simply wrong, forcing seniors into endless battles with customer service representatives and bill collectors over charges made in error. Many simply pay.
“A lot of them might end up saying, ‘Just put it on my credit card,’ ” says Krutika Amin, former director of policy and research at the Center for Consumer Information and Insurance Oversight of the U.S. Department of Health and Human Services.