JOEL BERVELL: 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 For, 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 nonprofit simply could not keep up with the request for assistance. Here’s why.
To quickly break this down, 40 percent 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.
JARED WALKER: Thanks so much for having me. Appreciate it.
JOEL BERVELL: 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 definition. Can you tell us what hospital financial assistance actually is?
JARED WALKER: Yeah. 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 financial assistance policy.
JOEL BERVELL: 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.
JARED WALKER: Yeah. It’s tough because I think, number one, hospitals don’t do a great job of telling people about it, right? I mean, at the end of the day, if a hospital can collect money, they’re going to prefer that. 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, “Hey, we have a program.” So I think it’s just the unfortunate reality of the billing cycle at a hospital. A lot of patients leave the hospital without any knowledge of these programs.
JOEL BERVELL: I also want to acknowledge, I mean, just the time that we’re in too and the added urgency there. Especially with ACA rollbacks and the anticipated impacts that are going to be made also on the 2027 Medicaid cuts. Can you talk about that a little bit?
JARED WALKER: Yeah. 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.” 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.
JOEL BERVELL: From your experience, is Dollar For now more relevant than when you launched about a decade ago?
JARED WALKER: 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 ever now. So it’s like maybe 10 years ago, people didn’t know, there was less awareness. But it was also more affordable.
JOEL BERVELL: 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 bit about insurance. But in the TikTok, people were calling you and saying that Humana and United Healthcare were sending patients saddled 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.
JARED WALKER: I’m still trying to figure it out. A few months ago, I started getting phone calls from unknown numbers and most of the time I’d send them to voicemail. And I started getting a bunch of messages and people were saying, “Hey, I got your number from my insurance,” UnitedHealthcare or Humana, Aetna, whatever, Blue Cross Blue Shield. And I was like, “Man, what’s going on?” One, how are they getting my personal number? That’s weird. And then also, why are insurance companies sending patients to me? So I started looking into it and I called a lot of the patients back to 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.”
I think that a couple 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 it’s out of network or whatever it may be. And I think that Dollar For is a resource that comes up on people’s radar and they send them off to Dollar For. 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 onto Dollar For.” So I haven’t gotten a clear answer on that, but I’ve got a lot of voicemails over the last few months, which has been weird.
JOEL BERVELL: Yeah. And I think it’s such a powerful example of how in some ways desperate people are 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 For?
JARED WALKER: Oh, absolutely. 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. 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.
JOEL BERVELL: Wow, wow.
JARED WALKER: 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, we’re in the middle of COVID, people are thinking about their health. 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.
JOEL BERVELL: How did you craft that first TikTok? Was it off the cuff? Or was it something that was produced? Was it from frustration?
JARED WALKER: It’s so funny because it’s like you can look at that original video and it’s grainy, it’s dark. I’m at the office late. I make a video. What ended up happening is I was scrolling and I saw that, what’s a piece of information that feels illegal to know? That was the stitch.
JOEL BERVELL: Yep.
JARED WALKER: I saw that and I was like, “Oh, I’ll just talk about charity care.” So I just hopped on, talked about charity care, 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.
JOEL BERVELL: 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?
JARED WALKER: Yeah, we have kind of messed around a lot with TikTok. So first was all of these financial literacy, like finance influencers were seeing the video and were 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 found this weird alignment. I was not expecting that. But the whole finance TikTok, Money Talk and all these different people started posting about charity care and saying, “Hey, go to Dollar For.” And these videos would get like millions of views. So that was like an accident.
And then we started doing, I guess, user-generated content. We would get people, “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 normal person say, “Hey, I got a hospital bill and I used this nonprofit and it was free and they got my bill to go away.” I think it’s powerful.
JOEL BERVELL: 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?
JARED WALKER: 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 how many people live in the household, how much money do they make, and 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.
JOEL BERVELL: And even just hearing you explain that, that’s something that . . . I know, and I’m curious about this, if you’ve worked with doctors on this at all. Because that’s something I would want to know. 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?
JARED WALKER: Yeah, we’ve had a handful of health care workers reach out to us and say, “Hey, can I . . . .” We have these 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. I think a lot of times patients ask 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, 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 they’re probably not teaching about the charity care policy.
So we’ve talked about trying to get QR codes on your little badges, lanyards, or whatever at hospitals to try to empower health care workers. So not as much as we would like, but we definitely work with some.
JOEL BERVELL: Yeah. And as I’m sure you know, there’s so much a lack of price 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 you have to consider all those different factors?
JARED WALKER: Yeah. So 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 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.
JOEL BERVELL: You’re also iterating on these digital tools. What can you tell us about what’s being built next to help people?
JARED WALKER: 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 10 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. Ninety percent of these messages could probably be answered with some type of AI patient advocate chatbot.
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.” 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 time.
So the hope is there’s a few of these like, it seems like small tools that would allow us to serve five to 10X the amount of patients with the same staff.
JOEL BERVELL: 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?
JARED WALKER: 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 a different sliding scale whether you have insurance or not. But a lot of times, think of charity care as it’s like the last line of defense that the hospital is going to put out. Because they’re going to try to get paid first. Are you insured? Do you have Medicare? Do you have Medicaid? Was this a car accident? Is there any type of personal injury protection? Was this workers’ comp? Who’s going to pay? And then if there’s no payer, then if you’re eligible for charity care, then they would write it off.
So when somebody has insurance, the insurance is going to pay whatever. I just went to the hospital a few months ago and I got 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.
JOEL BERVELL: 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.
JARED WALKER: Yeah. So I would say number one, a lot of people just disqualify themselves for charity care to say, “Oh, that’s not for me. I make too much money.” Or they compare it to food stamps or Medicaid and, “Oh, I didn’t qualify for that, so I won’t qualify for this.” These policies are much more generous 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. 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 write off the bill. Even if your bills are in collections, a lot of times hospitals will send your bill to collections after 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.”
JOEL BERVELL: 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?
JARED WALKER: So 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 and 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.
JOEL BERVELL: 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?
JARED WALKER: Every hospital association has been the one that we are fighting with when we go in. So same way . . . we tried to get this law passed in Texas, same thing. Texas Hospital Association, California, Oregon, Washington — that is always who we’re up against.
JOEL BERVELL: And I mean, I kind of want to dive into it a little bit because you appeared before the Texas State Legislature back in April of 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, exactly 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’ve failed?
JARED WALKER: 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 into Texas, “Who are you to tell us that we’re not good at 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. They’re very well funded, they’re very powerful groups.
And I get it. A lot of these hospitals are the biggest employers in their area. They are looked at in the community as they’re fantastic. They’re the children’s hospital, there’s this, and they are. 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 ruining people’s financial lives and they don’t have to be.
And that’s the whole thing is if people were to receive charity care if they were eligible, it’s not going to bankrupt a hospital. The hospitals aren’t collecting on these bills anyway. So when it came to Texas and other states that we fought in, it was really just a bummer that we’re fighting against the hospitals. I’d love to just work with the hospitals to find solutions that work for patients.
JOEL BERVELL: Was that something you were anticipating when you went on this journey that the bill wouldn’t pass just based on even looking at current and local environment and attitudes?
JARED WALKER: We did figure it would be a fight. Because I think that what ends up happening is hospitals get annoyed because of the administrative burden. It’s definitely an extra step, right? 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, “Well, this is how we do it. 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 a whole other world from the care side. This is 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 just the greed of, if we can collect, we’re going to try to collect. And I mean, we’ve seen this. This is not an outlier. But 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 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.
JOEL BERVELL: Yeah. And I remember that lawsuit from two years ago. It was a huge deal, it was all over the radio and the news. But I think half of me was not surprised for the exact reason that you said. I think about a lot of these systems, and now that I’m in this system 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 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.
JARED WALKER: Yeah, thank you.
JOEL BERVELL: 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 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 works for everyone?
JARED WALKER: We have hundreds of partners. It could be American Cancer Society, it could be a small local church, it could be a 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. And how I’m thinking about it moving forward is that you said something earlier where 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? People get it. And 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 powerful with 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. We got to fix it.” So that’s the idea is 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.
JOEL BERVELL: 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 trading 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 that 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?
JARED WALKER: 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 dollarfor.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 philanthropies. So if you need help, reach out.
JOEL BERVELL: Amazing. Jared Walker, thank you so much for coming on The Dose.
JARED WALKER: Thank you.
JOEL BERVELL: This episode of The Dose was produced by Jody Becker, Jesús 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 thedose.show. 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 Bervell, and thank you for listening.
