What Patients Don’t Know About Hospital Financial Assistance – But Should
Every year, hospital patients are billed $14 billion that should be waived through financial assistance, making “charity care” one of hospitals’ best kept secrets.
By law, non-profit hospitals must offer programs that forgive bills. Many for-profit hospitals also offer help through which patients’ bills may be reduced or eliminated. However, many people don’t know that such programs exist, leaving them without support as they struggle to pay off medical debt.
One non-profit organization is working to change the face of hospital financial assistance. Dollar For was established in 2012 to make hospital financial assistance known, easy, and fair. Dollar For has an ambitious goal: eliminating $1 billion in medical debt for patients in need by 2028. To date, the free service has helped more than 36,000 patients navigate and access hospital financial assistance programs, crushing over $120 million in medical debt and giving them breathing room to recover and rebuild.
Jared Walker
“Health care costs are not sustainable for most Americans,” said Dollar For Founder Jared Walker, who notes that Americans owe an estimated $220 billion in medical debt, the leading cause of bankruptcy in the United States. “It is the unfortunate outcome of a health care system that is driven primarily by profit and is not prioritizing or investing in the tools and resources needed to make charity care easier for hospitals to administer and patients to access.”
Making Charity Care Known, Easy, and Fair
Dollar For’s goal is to make hospital financial assistance:
- Known, by educating people about charity care, even if hospitals don’t.
- Easy, by helping patients apply for charity care through an easy-to-use patient support program.
- Fair, by holding hospitals accountable to the law and to patients.
“A big part of our mission is education,” Walker said. “Health insurance policies are dense, complex, and vary widely from payer to payer, making it incredibly difficult for even the savviest of patients to understand their benefits and coverage. When insurance claims are denied, it can seem like a black box that requires a law degree to decode. Plus, there’s an unfortunate shame or stigma around charity care which can cause some people to not explore their options.”
Dollar For’s free service helps patients through some of these challenges by applying for hospital financial assistance on their behalf. A bilingual, six-question online screener shows patients immediately if their hospital bill qualifies for assistance. If eligible, patients then complete a 15-minute form and provide recent pay stubs, tax returns, and bank statements. (Dollar For does not share this data with anyone except the patient’s hospital.)
After Dollar For has the needed information, its patient advocates prepare the financial assistance application and submit it directly to the hospital. After submission, patients can track their case in a secure portal. Dollar For also emails and texts each patient to check in and provide tips on following up with the hospital. If needed, Dollar For can help by submitting additional documents to the hospital and preparing for an appeal.
“Under federal law, non-profit hospitals must accept a financial assistance application for 240 days, or about eight months after they send you the first post-discharge bill,” Walker said.
In addition to its free service that removes the legwork burden from patients, Dollar For also offers an online Financial Assistance Handbook, a do-it-yourself manual that provides all the tips and tools patients need to apply for financial assistance directly.
What Happens When Patients Receive Hospital Financial Assistance
According to Dollar For, patients receiving hospital financial assistance report lower stress levels, better health, and improved food access. They are able to pay off other bills and save for their future.
“Patients tell us that once their hospital bills are cleared, they feel hope, relief, and the freedom to plan again – whether it’s returning to school, saving for a home, or simply sleeping through the night without fear,” Walker said.
Dollar For helped Savannah Newton wipe away a $4,244 hospital bill after two labor-and-delivery stays at her local hospital left her single-income household with a sizable medical debt and quickly-dwindling savings.
“[Medical debt] does not have to cripple your life,” she said. “Organizations like [Dollar For] can be your backbone.”
Dollar For also helped Sierra F. when she received her first hospital bill as an adult no longer covered by her parents’ insurance. After multiple emergency heart surgeries to treat her Loeys-Dietz syndrome, she was denied by her hospital’s financial assistance program twice before turning to Dollar For, which stepped in and got the hospital to waive over $13,000 in bills – and refunded the money she already paid toward the balance.
“I had gotten nowhere with [the hospital],” she said. “But the second Dollar For came in, they were like, ‘Okay, now we’re listening.’”
Providing charity care to patients does not have a significant impact on hospitals’ bottom lines, according to Walker. One Dollar For study found that while only 29% of eligible patients receive financial assistance, covering everyone would only reduce hospital revenue by 0.7%.
Defending and Expanding Hospital Financial Assistance Policies
Dollar For calls for more accountability and transparency in hospital financial assistance. The organization vows to support coalitions, advise local advocates, and engage directly with hospitals and legislators to enact reforms that ensure charity care is not just a policy on paper, but a meaningful protection for every patient who needs it.
“Hospitals, not patients, should be responsible for financial assistance,” Walker said. “They should proactively screen every patient up front and no patient should be discharged without being told about financial assistance programs – before billing begins.”
Dollar For also calls for improvements to the traditional financial assistance application process. Walker notes that while hospitals have invested resources in creating seamless payment plan processes, processes for charity care are clunky.
“Patients face unclear messaging, excessive documentation demands, tight and illogical deadlines, and eligibility criteria that are inconsistently applied,” he said. “In many cases, the process feels more focused on limiting access than offering support.”
Dollar For’s advocacy work also extends to strengthening medical debt collection protections so that no collections take place without proof that a patient was screened for financial assistance and found ineligible.
“That means informing the patient about available help, giving them a fair chance to apply, and documenting the outcome,” Walker said.
Dollar For has created guidance to help hospital leaders, policymakers, and community advocates expand access to hospital financial assistance. Its Hospital Toolkit offers practical guidance to help hospitals make financial assistance known, easy, and fair. Its Model State Legislation document provides foundational language for the development of state financial assistance laws.
Walker points to Oregon as an example of where improvements are happening. There, hospitals are required by law to screen patients for financial assistance needs before billing. Before the law went into effect, about 12% of patients at Portland’s Oregon Health & Science University (OHSU) received financial assistance – and only by request of the patients. Now, with presumptive eligibility screening, assistance is provided to over 60% of patients, placing $50 million back into the pockets of low-income Oregonians.
“Dollar For is eager to work with hospitals and health systems and assist them with the burdens associated with screening and applying for financial assistance,” Walker concluded. “We have lots of creative ideas for hospitals willing to make patient financial assistance a priority.”
