Dollar For helps millions dodge bankruptcy via charity care

A West Health–Gallup Healthcare survey found 31 million Americans owed $74 billion in medical debt in 2024. For Sierra Freeman, charity care secured through Dollar For helped shrink a $4 million hospital bill into a cost of hundreds of dollars—after two denial

The letter finally landed—weeks after Sierra Freeman had been living with the worst kind of financial uncertainty: a hospital bill that kept growing while her health struggled to stabilize.

Freeman’s emergency began in 2022 with heart-related care, but it escalated fast. A brain bleed kept her in the hospital for two months, and what she expected to be a short crisis turned into what she calls a “more than $4 million financial emergency.”

“It was certainly stressful,” Freeman said. “I was still recuperating and getting back to work and also had this $4 million bill looming in the background. Definitely not great for a condition that’s worsened by stress.”

Her story traces a path many Americans never get to walk—because they don’t know it exists. or because the paperwork is intimidating. It’s also a reminder of what’s at stake nationally. A West Health–Gallup Healthcare survey found that in 2024, 31 million Americans had accumulated $74 billion in medical debt.

Freeman’s first efforts went straight to the source—her care provider. She applied twice for financial aid from Stanford Health Care, where she was flown for specialized treatment, but was denied both times.

She said she and her mother initially doubted Dollar For. a free nonprofit that helps patients navigate and apply for hospital charity care programs. “We both thought it was a scam, initially,” Freeman said. But she weighed the options. The other routes she was finding online were things like creating a GoFundMe or declaring bankruptcy.

“I figured that the worst that could happen with Dollar For is that they applied on my behalf and I got denied a third time. ” Freeman said. “The other options I was finding online were things like creating a GoFundMe or declaring bankruptcy. so it was one of my better options. I had gotten nowhere with Stanford. But the second Dollar For came in, they were like, ‘OK, now we’re listening.’”.

The health insurance company eventually covered the bulk of her bills. But Dollar For pushed for charity care that dramatically changed the rest. Freeman said it cut her portion down to hundreds of dollars—from tens of thousands.

Dollar For’s work is built around a simple premise: some of the bills people are drowning in may be legally forgivable, if patients qualify for charity care and know how to apply.

Charity care is free or discounted medically necessary inpatient and emergency services from hospitals to patients who can’t afford their medical bills. Patients typically must meet specific household income and financial hardship criteria.

The IRS describes charity care as free or discounted healthcare for patients who meet an organization’s eligibility criteria for financial assistance and cannot pay for all or a portion of services. Hospitals. however. set their own eligibility criteria and decide whether they extend charity care to both uninsured and insured patients. KFF has said. Federal law requires nonprofit hospitals—nearly three-fifths (58%) of community hospitals—to provide some level of charity care to maintain tax-exempt status. KFF also said many state governments require all or some hospitals to extend eligibility for charity care to certain groups of patients.

Those rules don’t always translate into easy access for patients. Freeman’s experience—two denials for financial aid at Stanford Health Care before charity care support—shows how quickly costs can spiral when the process isn’t understood.

The barriers can be procedural, too. To receive charity care, patients usually must apply at the hospital where they received care. Each hospital has its own rules for how to apply, who is eligible, and how much charity care is provided. Hospitals typically weigh patient income, the number of people in the household, and the bill’s age.

Jared Walker, Dollar For founder, framed the problem bluntly. “Medical debt is the #1 reason people file for bankruptcy, but they don’t have to,” Walker said. “They’re filing bankruptcy or getting on payment plans for bills they don’t have to pay.”

Walker said patients often don’t apply because they don’t learn about charity care soon enough—or at all. “The law only says a hospital has to have a financial assistance policy that has to be widely publicized and available. ” he said. “So, they put a poster up in the ER and it’s widely publicized. They put it on a page on their website and it’s widely available.” But. he added. “it’s really a best-kept secret.”.

What makes charity care difficult for many people isn’t only awareness—it’s the process. Walker said informed patients can ask hospitals for financial assistance, but even then the application can be daunting. “Hospitals will still want you to fax or mail in applications,” Walker said.

Dollar For says it aims to reduce the friction by building databases that map hospital policies nationwide and by handling the negotiation side. Walker said the nonprofit has databases of most hospitals across the country with their policies and requirements. and that it knows how to negotiate medical debt.

“Our process is easier than any hospital in the nation,” Walker said. “If you know what’s your household income and size and what hospital you were in, you can know within seconds if you’re eligible for charity care.”

If a patient qualifies, Dollar For says it handles the paperwork. “Submit the paperwork, and hopefully wipe out those medical bills. They don’t pay your bills; they get the hospital to forgive them. And their services are entirely free,” Triage Cancer wrote on its website.

Triage Care, a national nonprofit providing free education on the legal and practical issues that may impact cancer patients and their caregivers, is one of many partners that send patients to Dollar For for help.

For people confronting a bill they don’t expect to be able to pay. Walker offered a straightforward starting point—one that centers on what hospitals will accept in a settlement. “The first thing people should do if they get a giant bill when they go home is think of charity care. ” Walker said. “Why care about a bill you don’t have to pay?. You can almost always negotiate medical bills. We even have scripts and resources on Dollar For to help. The line everyone needs to remember is, ‘What is the settlement amount?’”.

He said hospitals often accept a lump-sum settlement to close an account, and that “just that can consistently get you 30% to 40% off your bill,” Walker said.

Walker’s comments sit against the scale of the debt problem: Dollar For has submitted 50,000 financial assistance applications to “save Americans more than $151 million in medical debt,” Freeman’s case illustrates what that support can mean in individual terms.

Freeman’s outcome wasn’t a story of instant relief. It was a long stretch of medical crisis. followed by repeated denials. then a second attempt that finally shifted the conversation. After insurance covered the bulk. charity care brought her remaining portion down to hundreds of dollars—changing the experience of recovery from financial fear to something closer to stability.

For patients who feel cornered by medical bills, the message embedded in Freeman’s timeline is stark: bankruptcy and payment plans aren’t the only route—sometimes there’s a path already available through charity care, if someone helps you find it and finish the application.

medical debt charity care Dollar For Sierra Freeman Stanford Health Care West Health-Gallup Healthcare survey KFF IRS financial assistance bankruptcy negotiation