The Dose - Fighting Medical Debt? There's an App for That (feat. Jared Walker)

Episode Date: April 3, 2026

Four in 10 Americans have medical debt. Most don't know there's a federal law that could eliminate it. On this episode of The Dose podcast, host Joel Bervell talks with Jared Walker about his nonprofit, Dollar For, which has helped Americans erase more than $100 million in medical debt by connecting them to the charity care programs that hospitals are legally required to offer but rarely publicize. "These hospitals are great. They're saving people's lives every single day," says Walker. "The problem is that they're also ruining people's financial lives." With Medicaid cuts on the horizon and health care costs continuing to rise, Walker explains how Dollar For's free screening tool works, why some states are doing a better job of protecting patients than others, and what it will take to make hospitals do what the law already requires.

The DOS is a production of the Commonwealth Fund, a foundation dedicated to health care for everyone. My guest on this episode of The Dose is Jared Walker. Right now, he's doing something so profoundly necessary that the spiraling demand for his services meant he literally had to stop advertising. Full stop. As the founder of Dollar 4, Jared Walker is in the business of helping people eliminate hospital debt. So far, his efforts have helped Americans erase over $100 million worth of medical debt. And once he got on TikTok and then started buying digital ads, well, his dollar for non-profit simply could not keep up with the request for assistance.

Here's why. To quickly break this down, 40% of Americans have some medical debt. Nearly three quarters of that is related to a hospital visit or a stay. So we're talking about around 70 million people in the United States. facing this kind of financial pressure. For some, it could be a couple of thousand dollars. For others, it can be hundreds of thousands of dollars. Jared has been there.

He wanted to do something about this. And on this episode, we'll talk about how he created digital tools to help Americans find relief from medical debt and how he keeps iterating on his tools with evolving AI. This kind of help, reducing or even eliminating hospital bills can make a real difference. But at the end of the day, it's still more of a band-aid than a long-term fix. It helps people in the moment without really addressing what's broken in our health care system.

So in this episode, we're also going to look at what some states are doing to tackle medical debt more broadly and how lawmakers in other places are starting to think about protecting patients who went in for care and walked out with massive bills they didn't need to pay. If only they'd had the right information. Jared Walker, thank you so much for joining me for this conversation. Thanks so much for having me. Appreciate it. So this conversation is personal for both of us, because you have been in need of care and face these financial stressors yourself.

And right now, I'm doing my residency. I work in a hospital, and every day I see the impacts of financial stressors on patients and their families. So nothing's abstract about this for me. And we're also in a moment that makes this conversation so critical. But I wanted to start off by asking you for a question. a definition. Can you tell us what hospital financial assistance actually is? Yes, so hospital financial assistance, also known as hospital charity care, is basically a federal

law that requires hospitals to reduce or completely waive hospital bills. So this is section 501R of the Affordable Care Act, and it's basically in exchange for these hospitals' nonprofit tax-exempt status, they have to provide community benefit. And community benefit includes charity care, which is free or reduced care for low-income patients. So every hospital, almost every hospital in America has a charity care or financial assistance policy. Why don't more people know about charity care or hospital financial assistance? I mean, I even think about myself, when I started residency, I had no idea it even existed until I had to actually request it. Yeah, you know, it's tough because I think number one, hospitals don't do a great job of telling people about it, right? I mean, if at the end of the

day, if a hospital can collect money, they're going to prefer that, right? And I think that that's priority. And then if a patient can't pay or they're going to be sent to collections or something like that, maybe it's, you know, hey, we have a program. So I think it's just a unfortunate reality of like the billing cycle at a hospital. You know, a lot of patients leave the hospital without any knowledge of these programs. I also want to acknowledge, I mean, just the time that we're into and the added urgency there. especially with ACA rollbacks and the anticipated impacts that are going to be made also on the 27 Medicaid cuts. Can you talk about that a little bit? Yeah, you know, we're unfortunately kind of

gearing up to be busy. And I think medical debt and health care is just going to be more and more expensive for people. I think that we're going to see, and I think we've kind of already seen with the premiums going up, is people just saying, hey, I can't afford it. You know, we know that one in four Americans neglect care that they need because of the cost. And I think that that will probably get worse, unfortunately. From your experience, is Dollar 4 now more relevant than when you launched about a decade ago? Oh, man. I mean, I think so. I think that it's tough because I do think that there's a lot more awareness of financial assistance in charity care now because of TikTok and social media and people getting the word out. But health care is more expensive than

never now. So, you know, it's like maybe 10 years ago, people didn't know there was less awareness, but it was also more affordable. Absolutely. Well, before we dig into the specifics about the work that you do on behalf of people, I also wanted to mention that I love that we both have the experience of experiencing the power of positive social media, especially on TikTok. A few days ago, you posted a TikTok that was pretty wild. We'll also talk a little about insurance, but in the TikTok, people were calling you and saying that Humana and United Healthcare were sending patients saddle with debt your way by sending them your personal phone number. Tell me a little bit about that and just what you thought about that happening.

You know, I'm still trying to figure it out. A few months ago, I started getting phone calls from unknown numbers and I, most of the time, I'd, you know, send a voicemail. And I started getting a bunch of messages. and people were saying, hey, I got your number from my insurance, United Healthcare, or Humana, Edna, whatever, Blue Cross Blue Shield. And I was like, man, what's going on? How are they, one, how are they getting my personal number?

Like, that's weird. And then also, like, wire insurance companies sending patients to me. So I started looking into it, and I called a lot of the patients back, say, okay, so what happened? And so, yeah, I was talking to my insurance, and they said that they couldn't cover this. and they told me to reach out to you. You know, I think that a couple of things are probably happening. One, I think that, as we know, a lot of times, insurance will deny claims that they shouldn't or they just make it hard for people to get the care that they need or, you know,

it's at a network or whatever it may be. And I think that $1.4 is a resource that comes up on people's radar and they send them off to $1.4. I think that there might be some customer service representatives that just know about our work through TikTok and whatever and genuinely want to help patients and are just trying to send them resources. And I also think that best case scenario, that's it. It's just a kind customer service person that's trying to help someone out. And the bad version is, yeah, insurance companies have kind of figured out, okay, well, we can deny some of these hospital claims and we can

kind of pass the buck on a dollar four. So I haven't gotten, you know, a clear answer on that. But I've got a lot a lot of voicemails over the last few months, which has been weird. Yeah, and I think it's such a powerful example of how, in some ways, desperate people are, right, to reach out to a random phone number and just hope that you can offer some help on the other end. Do you think the momentum from TikTok was integral to the growth of dollar four? Oh, absolutely. You know, I was single person, one-man show over here in Portland, Oregon, trying to help people

pay their hospital bills through crowdfunding. And then I started talking about charity care on TikTok. It was I had zero followers. I had zero videos. It's the first video I ever made. I made a 60 second video that told people what charity care was. And it got like 30 million views. So it was like one of those things that launched the organization overnight.

We were a national organization because I had tens of thousands of people reaching out for help with their hospital bills. I had no idea that that was even possible. That was at the beginning of 2021. If you think back then, you know, we're in the middle of COVID. People are thinking about their health, right? They're stressing about hospital bills, doing whatever. So I think that it was just kind of this perfect storm, the timing of it and the message. And it was really something that people hadn't heard of.

How did you craft that first TikTok? Was it off the cuff or was it something that was produced? Was it from frustration? It's so funny because it's like you can look at that original video and it's it's grainy like it's dark. I'm at the office late. I make a video. What ended up happening is I was scrolling. I saw that what's a piece of information that feels illegal to know?

That was like the stitch. I saw that and I was like, oh, I'll just talk about charity care. So I just hopped on, talk about charity care, you know, flipped my phone around, showed my computer screen. This is how you do it. This is how you look it up. So I was just walking people through the process. And yeah, it just blew up. It's as simple as that, showing people something that you found surprising, that other people

might find surprising too, that like you said, feels illegal, but actually could be life-changing. And then there was the follow-up TikTok campaign as well. What about that? Yeah, you know, we have kind of messed around a lot with TikTok. So first was all of these financial literacy, like finance influencers, were seen the video and were like making their own version of it because again they had never heard of charity care and it was like well this is great content to help people save money so we've kind of like found this weird like alignment i was not expecting that but like the the whole finance tic talk

you know money talk and all these different people started posting about charity care and saying hey you know go to dollar four and these videos would get like millions of views so that was like an accident. And then we started doing, I guess, like user generated content. We would get people, you know, hey, we're trying to eliminate medical debt in Dallas. Let's get somebody from Dallas to talk about charity care. And those have done really well. I think that when people see just a, you know, a normal person, say, hey, I got a hospital bill and I use this nonprofit and, you know, it was free and they got my bill to go away. I think it, you know, it's powerful. Yeah, that's powerful. So I kind of want to talk about specifically what you guys are doing.

right now. You have a calculator on your website. It's front and center. Can you explain what's being calculated there? So there are about 8,000 hospitals in America and every single one of them has their own financial assistance and charity care policy. So this is not a standardized. It's like the hospitals choose how generous these policies are. And what we did early on was we got like 50 volunteers and we just went through. and we found every single policy, and we put it in this database. So we have every single hospital charity care policy, all of their eligibility criteria, and it goes into this database, and that is the logic that powers the tool.

So you're going to put in your household size, your income, what hospital, how old the bill is, and it's going to tell you, according to that hospital, whether or not you're eligible for charity care. because most of the time charity care is going to be based off of, you know, how many people live in the household, how much money do they make, and, you know, what hospital, how old the bill is. So if we can get that information, it can spit out the answer. And then from there, we lead people through a digital application. And even just hearing you explain that, that's something that I know. I'm curious about this if you've worked with doctors on this at all, because like that's something I would want to know, right? oftentimes I'm going to a patient and I'm talking with them and they say, I can't afford this. And the next step for us is to then reach out to the case manager and hope that the case manager kind of gets back to us with all that information. But I'm curious, yeah, just for my personal own benefit, have doctors worked with you on this or said that it's helpful for them getting patients affordable care?

Yeah, we've had a handful of healthcare workers reach out to us and say, hey, can I, you know, we have these like little touch cards with the QR code. Like, can I give these out? Absolutely. we've gotten some people that the hospital said that they can't do that. But we've had some health care workers get pretty creative with how they share. You know, I think a lot of times patients ask, you know, the doctor or the nurse, like, hey, what's this going to cost? And it's like, you all aren't going to school to study hospital finance, right? Like, you don't know how much it's going to cost. So I think that it kind of puts the health care workers into a bad situation because they want to be able to provide care and provide resources to people. And it just, They're probably not teaching about the charity care policy. So we've talked about trying to get QR codes on your little like badges, lanyards or whatever at hospitals to try to like empower health care workers. So not as much as we would like,

but we definitely work with some. Yeah. And as I'm sure you know, there's so much a lack of transparency as well in terms of whether it depends on your insurance, like you're saying where you're from, what hospital you're at, what system you're in the year,

if there's any federal policies behind it. how do you keep all of that current as pricing can be so dynamic when it we have to consider all those different factors yes we have a scraper that goes through every quarter and it goes through every single one of these policies and if the hospital changes the policy we get notified and then we go and update all of the database because yeah it changes and recently because of Medicaid cuts and other stuff going on we've found that some hospitals are having to to kind of reel back their charity care policies make it a little less generous. And then sometimes states will pass state laws that require hospitals to be more generous,

which is great. And then we adjust from there. So we're constantly watching. You're also iterating on these digital tools. What can you tell us about what's being built next to help people? Right now, people are able to see immediately, like step one was like, can I tell someone if they're eligible within seconds? So once we were able to do that, then it was, can we get somebody to be able to apply right then and there? Because if you were to reach out to most hospitals and say, hey, I'd like to apply for your charity care program, they would most likely mail you a packet in seven to ten business days and ask you to fax or mail it back.

Not a great system, right? So what we did is we went through and found every single application and we mapped them all digitally. So when you are on your phone, tablet computer, if you're typing in your information, it's automatically mapping it over to the correct hospital form, and then we send it. The next thing we did was we made a patient portal. So now you can text back and forth with a patient advocate if you have questions and you can check the status of your application and all of that. The next thing that we want to do is implement some AI tools into this process, because this is such a great use case for AI. There's so many things that are just repeated. So like the patient advocates, they're getting asked

the same couple questions every single time and they're manually answering them or copy and pasting from templates. 90% of these messages could probably be answered with some type of AI patient advocate chat bot. Another thing that we're trying to do is have document recognition. So if one of the things that patients have to do is they have to submit proof of income to be able to show the hospital, hey, I'm within the income range. You know, so you're uploading three months of pay stubs or a tax return. Sometimes they only upload two of the pay stubs and they need three or whatever. Our system doesn't catch that. So sometimes we're sending inaccurate or not enough information to the hospital. If we could have an AI kind of look at, does this match up with what they said

that they had before we send it? It would save everybody a bunch of times. So the hope is there's a few of these, like, it seems like small tools that would allow us to serve 5 to 10x the amount of patients with the same staff. Absolutely. I briefly want to touch on the insurance question too. In terms of if the person you're helping is insured, how does that insurance factor into any hospital financial assistance that they may qualify for? Yeah, so sometimes hospitals will say, if you have any type of insurance, you're not eligible for financial assistance. That is rare, but it does happen. We would argue that that's illegal, but some hospitals do it.

The other thing is that there might be a different policy or different sliding scale, whether you have insurance or not. But a lot of times, think of charity care is, it's like the last line of defense, right, that the hospital is going to put out because they're going to, they're going to try to get paid first. You know, are you insured? Do you have Medicare? Do you have Medicaid?

Was this a car accident? Is there any type of like personal injury protection? Was this workers comp? Like who's going to pay? And then if there's no payer, then if you're eligible for charity care, then they would ride it off, right? So when somebody has insurance, the insurance is going to pay whatever.

Like I just went, you know, I just went to the hospital a few months ago. and I got like a $750 bill. If I was eligible for charity care, I could apply for that out-of-pocket expense, but the insurance had already covered whatever that portion is. So that's how it usually works. That's a great answer,

and it really highlights to just how much people wouldn't realize that there is still opportunities for them, even if they're insured. And for many patients that I have, even with insurance, they're not able to afford the medications that they need to get, right? And so it's a huge, huge, asset. Yeah. So I would say number one, a lot of people just disqualify themselves for

charity. Say, oh, that's not for me. I make too much money. Or they, they like compare it to, you know, food stamps or Medicaid. And oh, I didn't, I didn't qualify for that, so I won't qualify for this. These policies are much more generous than, than those policies. If you're a family of four making under $100,000 gross annual income, you are most likely eligible for some discount at most hospitals in America. And then there's other things about it, too. Like, let's say that you've been on a payment plan for a year and then you find out, oh my gosh, I'm eligible for charity care. You can apply. The hospital would have to refund you whatever you've paid on that payment plan and then discount the bill or right off the bill. Even if your bills are in collections,

a lot of times hospitals will send your bill to collections after like 120 days of no payment. you're eligible for charity care up to 240 days. So you can be in collections, but still eligible for charity care. And a lot of times people just think, this isn't for me or, oh, I'm in collections, it's game over, or I've already committed to a payment plan. I can't apply.

It's like, no, you absolutely can. Yeah. These are great things that I'm thinking about for my patients too, because I've had so many situations. So I'm like, I'm taking notes right now. Well, but even beyond that, your website offers so many helpful insights for people living in every state.

And I kind of want to talk about that to illustrate differences between states. So two states with very different realities for patients. Let's say Alabama and California. And let's maybe start with Alabama. What's a typical scenario for a person who comes to your website seeking help from that state from Alabama?

So, you know, it's interesting. From what I understand is Alabama does not have a state law that requires any type of additional protections for financial assistance. So they are under section 501R, which is very broad and very vague. So it's like a hospital that is a nonprofit has to have a charity care policy. And that policy must be widely publicized and widely available. That's it.

So if you're a hospital, the minimum requirement for you is like if we put a poster in the ER, it is widely publicized. If we put a link on our website somewhere, it's widely available. So that's like when we first started this work, it was crazy how hard it was to find these policies because they were hidden. So in a state like California or Oregon or even Washington, they've created a state law that is going to say, hey, we can do this a little bit better. So in Oregon, hospitals are required to screen you for charity care before they can send the bill.

So they can't even send the bill without first checking to see if you're eligible for charity care. California passed the same bill last year. I think that goes into effect in 2027. And so there's just a little bit more like when you're in these hospitals, you're probably going to be told about charity care a couple different times. You're probably going to have a caseworker, a social worker, or a patient navigator call you and say, hey, do you need assistance, where in some of these other states, they just haven't created any additional protections for patients. And what hospitals have done, they have put the burden on the patient.

The patient needs to find out about the program. They need to navigate the program. They need to apply, do all the things, and jump through the hoops. When in reality, the law is like, no, hospital, you're receiving this tax exempt status. You're receiving the benefits. It is actually your responsibility to screen patients for the program. And I think that that's gotten a little bit mixed up over the years. Yeah, and I feel like it's been left out of the policy conversation. I'm sure that most people, regardless of political spectrum, would agree that hospital costs are just too expensive and that this is something that everyone should know about.

And I think, if I remember correctly, the California Hospital Association lobbied against the bill. Is that correct? Every hospital association has been the one. that we are fighting with when we go. And so same when we tried to get this law passed in Texas. Same thing. You know, Texas Hospital Association, California, Oregon, Washington,

that is always who we're up against. And I mean, I kind of want to dive into a little bit because you appeared before the Texas state legislature back in April last year, adding your testimony in support of a bill that would essentially require hospitals to evaluate and inform patients about charity care eligibility before sending the bills. what we're talking about. The bill failed. It didn't pass. Can you just share a little bit about that experience, what it taught you about just having to fight for something like this and the pushback you received against it as well, about why it maybe might have failed? You know,

I think back on that because I'm like, what could we have done better? What could we have done? And I really just think it takes time. I think that when you're somebody from the Pacific Northwest coming in to Texas, you know, who are you to tell us that, you know, we're not good of charity care? And I think that there's a lot of connections that we didn't have. And the hospital associations are very, very powerful groups, you know, they're very well funded. They're very powerful groups.

And I get it. You know, a lot of these hospitals are the biggest employers in their area. They are looked at in the community as like they're, you know, fantastic. You know, the children's hospital, there's this. And they are. Like, that's the problem. It's like, these hospitals are great, right? They're saving people's lives every single day. The problem is that they're also, like, ruining people's financial lives and they don't have to be. And that's the whole thing. It's like, if people were to receive charity care, if they were eligible, it's not going to bankrupt a hospital. Like, the hospitals aren't collecting on these bills anyway.

So when it came to Texas and, you know, other states that we fought in. and it was really just a bummer that were fighting against the hospitals. I'd love to just work with the hospitals to find solutions that work for patients. Was that something you were anticipating when you kind of went on this journey that the bill wouldn't pass just based on even looking at current and local environment and attitudes? You know, we did figure it would be a fight because I think that what ends up happening is hospitals get annoyed because of like the administrative burden, it's definitely an extra step, right? Like, if you're going to vet somebody for charity care, it's another set of questions you have to ask. It's a little bit more time.

And I think that hospitals are just kind of stuck in the, you know, well, like, this is how we do it. You know, we bill, we put them through the billing cycle. I mean, I spent a year of my life going to hospital financial management or whatever. It's like talking to these groups that are doing the billing cycle. I'm like, this is like a whole other world from the care side, right? Like this is like how hospitals operate and how they bill and all of that. And it's a total mess. And I think that to add another layer of, okay, well, now we have to vet everybody for charity care. I think that there's obvious pushback for that. And then I do think that there is like just the greed of if we can collect, we're going to try to collect. And I mean, we've seen this. Like this is not an outlier, but like in Washington

state, Providence Hospital. They, got sued and had to pay out $180 million because they were charging and trying to get patients to pay that they knew were eligible for financial assistance. So it's like they're not holding their part of the bargain. It's like, hey, you're a tax exempt. You get these benefits. You need to be telling people about charity care. And they're trying to get all the benefits from being tax exempt and not give out the charity. Yeah. And I remember that lawsuit from two years ago. It was a huge deal is all over the radio and the news, but I think half of me was not surprised before the exact reason that you said. I think about a lot of these systems. And now that I'm in the

system, right, as a doctor, I think a lot about the pain points and how people get so stuck in their ways of something that they don't want to add that extra step, even when it's the best thing to do for patients in terms of both health and just outcomes just overall. But I just just to say thank you to you for sticking with that fight because I think the more people know about it, the more the system can start to change when people realize there's another way. Yeah, thank you. And even just thinking back to that experience for you in Texas, how are you thinking now about this year, or maybe even a couple of years ahead in your work? Like we talked about at the kind of top of this conversation, just one example,

we're going to be seeing significant historic cuts to Medicaid. And is part of your work around financial literacy? Do you have partners trying to expand that among Americans? and especially even young adults, how do we start kind of taking these lessons and moving forward to create a system that's more equitable and worse for everyone? You know, we have hundreds of partners. You know, it could be American Cancer Society. It could be a small local church. It could be, yeah, financial literacy organization.

And I think that that's something we can definitely grow in. We've been thinking a lot about how we can partner with more groups that are trying to just make people's lives easier because it's rough out there, right? And like how I'm thinking about it moving forward is that you said something earlier where, you know, both sides of the aisle can get on board with this. When you go out and talk to people, most people can get on board with the idea of not losing everything because you get sick, right? Like people get it. And, you know, we have had big support from the right and the left with these bills. So I think that what I want to do is I want to make it so obvious and so. so powerful with patient, real patient stories. So in Texas, we're going to go all in in 2027,

their next legislative cycle. And our goal is to eliminate $15 million in medical debt for people in Texas in the next year and create an army of patients that can go to these things and say, hey, this hospital never told me about this. Like, we've got to fix it. So that's the idea is like the more people, the more patient stories that we can tell and empower the patient. to do that, I think is how we get this out there. Absolutely. Well, Jared, I want to say thank you so much for this conversation and for the work you're doing.

As someone, like I said, that's training right now inside a hospital, I unfortunately have an up close about how financial stress impacts families, patients every single day, and the lasting impacts it has in my patients that I then see in the clinic. And I think what you've built isn't just a tool. It's access, it's information. And what everything I'm all about is how do we give more information to people? Because that's at the end of the day, the power in a system. And you guys are really trying to solve that right now.

So I just want you to also tell people, if they're listening, if they're dealing with hospital debt, where do they find you? What do they do? Yeah, so first I always tell people, no shame. No shame in hospital bills, no shame in medical debt. I know a lot of people feel a certain way asking for help. You are not alone. Medical debt is the number one cause of bankruptcy in America. And if you have a hospital bill that you can't afford, go to dollar4.org.

The first thing you'll see is our screener. You'll put in your information and see if you're eligible and go from there. Our services are completely free. We are fully funded through donations and philanthropy. So if you need help, reach out. Amazing. Jared Walker, thank you so much for coming on, The DOS. Thank you.

This episode of The Dose was produced by Jody Becker. Jesus Alvarado and Naomi Leibowitz. Special thanks to Barry Scholl for editorial support. Matthew Simonson for recording assistance. Jen Wilson and Rose Wong for art and design. And Paul Frame for web support. Our theme music is Arizona Moon by Blue Dot Sessions. If you want to check us out online, visit the dose.com.

There, you'll be able to learn more about today's episode and explore other resources. That's it for the dose. I'm Dr. Joel Breveld, and thank you for listening.