Startup Automates Hospital Charity Care
Patient advocacy group Dollar For has successfully automated the entire hospital charity care application process. By using document workflow automation, they streamlined complex paperwork with e-signatures and mobile data collection. The case study demonstrates the value of digitizing all revenue cycle documentation, not just claims, to reduce manual work and speed up financial clearance.
The Affordable Care Act legally requires nonprofit hospitals—nearly 60% of community hospitals in the U.S.—to offer charity care as a condition of their tax-exempt status. However, federal regulations lack specific standards, allowing the 8,000+ hospitals in the country to set widely varying eligibility criteria for this financial assistance. This lack of standardization creates a significant access barrier for patients. Dollar For, founded by Jared Walker after his own family's struggle with medical bills, discovered that less than a third of people who qualified for charity care were actually getting their bills forgiven. This gap represents a potential $14 billion in medical debt that hospitals could be forgiving annually under their own existing policies. The scale of the problem is immense, with total U.S. medical debt estimated to be as high as $220 billion, affecting roughly 100 million people. In 2024 alone, about 31 million American adults had to borrow a collective $74 billion just to cover healthcare costs. Since pivoting from a crowdfunding model to focusing on charity care applications, Dollar For has helped erase over $110 million in hospital debt. The organization gained significant traction after a viral TikTok video in 2021 educated millions about the existence of these hospital financial assistance programs. For hospitals, this issue falls under the umbrella of uncompensated care—the sum of bad debt and financial assistance—which has cost U.S. hospitals almost $745 billion since the year 2000. Automating the charity care process not only aids patients but also provides hospitals a more efficient way to manage these mandated programs and clarify a portion of their bad debt. The automation of this niche corner of the revenue cycle reflects a much broader industry trend. The outsourced Revenue Cycle Management (RCM) market is projected to nearly double in the next four years, with AI and automation expected to generate hundreds of billions in annual savings by streamlining claims, reducing errors, and improving financial clearance.
