US medical debt financing groups vie to be ‘solution' to struggling rural hospitals

Medical debt financing and 'patient access' companies are pitching their services to struggling rural hospitals nervous about keeping the doors open, as congressional Republicans consider healthcare cuts that could leave 16 million Americans without insurance.
These companies, who act as middlemen between hospitals and patients, told the Guardian they could be a solution for cash-poor hospitals seeking to get paid by 'subprime patients' – especially the low-income, uninsured and unbanked.
'These guys are losing money – it's not sustainable,' said Chris Stenglein, CEO of Curae, about hospitals and healthcare providers. Curae is a company that charges hospitals a fee to find money from all sorts of sources – including patients.
'I believe the next huge bailout is going to be health systems.'
Middlemen are nothing new to American healthcare – the Commonwealth Fund found that the administrative complexity of US healthcare accounts for nearly one-third of the sky-high price of care in the US.
What is new is the potential market disruption created by Republicans. A bill passed by House Republicans before Memorial Day would cut Medicaid by $804bn and Obamacare, formally known as the Affordable Care Act, by $301bn – changes in Republicans' 'big, beautiful bill' that are expected to result in 16 million newly uninsured Americans by 2034. That disruption represents risk for hospitals and patients, but an opportunity for business.
'This really underscores the through line between Medicaid cuts today equal medical debt tomorrow,' said April Kuehnhoff, a senior attorney at the National Consumer Law Center (NCLC). 'This is really going to harm the most vulnerable patients in the United States.'
Hospitals face a real risk of not staying afloat: margins at the nation's roughly 3,000 non-profit hospitals, about half of all nationally, reached an eight-year low in September 2023, according to a recent report from the consulting firm Deloitte. Operating margins were just 0.8% on average that year.
'Providers carry more consumer paper than all of your regional banks combined,' said Stenglein, referring to consumer debt. 'In some cases, they got $1.3bn they write off every year.'
Stenglein views himself as a good guy in this fight, working in a 'dysfunctional' system to help people like his own parents. His mother worked at the grocery store chain Winn Dixie and his father was a truck driver. Started eight years ago, Curae is now a subsidiary of Atlanticus Holdings Corporation, which owns a portfolio of credit cards for subprime borrowers. The publicly traded corporation is valued at $794m.
Firms like Curae offer an appealing pitch to hospitals, finding money from every conceivable source, such as insurers, discount drug programs, philanthropy and patients.
But none of these services are free. Like the back end of a credit card, Curae charges hospitals a 'processing fee' for every transaction, Stenglein said in an interview. In written questions, Curae later declined to confirm its processing fee rate, stating: 'Our program management fees are confidential.'
Curae also facilitates financing to patients, specializing in payment plans and interest-bearing loans to patients who are 'higher risk/subprime patients, who usually would never get approved for any sort of credit', a spokesperson told the Guardian. Curae is not a lender, but brands loans through the Bank of Missouri. The spokesperson said Curae-branded loans were available to patients who would struggle to 'even be approved for other loans such as for cars'.
However, Curae does not refer patients, including the marginalized consumers the company specializes in, to non-profit hospitals' charity care programs. 'No, the hospital administers that program,' the company said in written questions. But it helps 'enroll eligible patients in third-party charity programs to help cover patient's expenses', which are not part of the hospital's programs
Curae-branded loans are 0% interest for patients up to 24 months. Longer-term loans cost between 9.9% and 36% based on creditworthiness, according to a June 2021 cardholder agreement. Stenglein said only 3-4% of the 'patient population' sign up for interest-bearing loans, which together with payment plans represent about one-fifth of the business.
A more recent cardholder agreement provided by Curae showed a long-term APR of 14.99%, although the cardholder agreement represented an approved rate for one individual borrower, and not the full range of possible rates. Curae later shared a cardholder agreement from October 2024 that showed a maximum interest rate of 26.99%.
Some patients have lodged complaints about this system publicly, including an Arizona teacher who said she was 'infuriated' when she was signed up for a credit card without her knowledge.
'I got a hit on my credit saying somebody did a hard look at my credit, and of course I was freaking out, like what is going on?' Kerry Morgan told local TV station AZFamily. 'Come to find out, it was Banner [Health],' a non-profit hospital system that partners with Curae, 'hit my credit and signed me up for a credit card to put the payments on'.
Despite fees hospitals must pay on top of already low margins, and the potential for patient complaints, some providers still find the deal enticing.
'Hospitals simply do not have the sophisticated skill to squeeze money out of patients,' said Ge Bai, a professor at Johns Hopkins Carey Business School and a healthcare accounting expert.
'We're going to see more and more businesses like that that help hospitals enhance revenue. You're already seeing a flourishing, thriving industry,' of financial middle men.
A testimonial sent to the Guardian by Curae provides a window into this appeal: a Banner Health employee said Curae helped the hospital 'improve collections' at the 'point of service' (their healthcare facilities) 'by $22m compared to 2023'. More than 90,000 patients applied for financing with Banner in 2024.
'I've worked in the field of Patient Access [sic] for 22 years,' wrote Jarrod Brown, senior director of patient access at Banner Health. 'Curae has been a major win for our patients, by providing a financing option focused on their healthcare needs.'
Kuehnhoff said Curae's specialism in the 'subprime patient', called into question whether hospitals are pushing patients who might be eligible for free or discounted care – known as 'charity care' – into payment plans.
'Does this person who needs medical financing actually qualify for charity care through the hospital? And are they being shunted to a medical financial product rather than appropriately given the assistance they qualify for?' Kuehnhoff asked rhetorically.
Traditionally, hospitals have provided patients with interest-free payment plans and the majority still do. A recent research letter published in Jama Health Forum found only 8.5% of hospitals promote what the study described as 'interest-bearing' payment products.
'Hospitals have really tried to step up to offer long-term payment plans for at least some of the patients within some income brackets – to try to work with people,' said Erin Duffy, a scholar at the University of Southern California's Schaeffer Institute and a co-author of the study.
But insurers have increasingly pushed costs on to consumers, which has forced hospitals to collect directly from patients.
By 2022, medical debt was the most common form of debt in collections, according to the Consumer Financial Protection Bureau (CFPB), and most patients in debt to hospitals were insured, according to a widely cited report. The same year, about one-quarter of American adults said they had a past due medical or dental bill, according to a survey by Kaiser Family Foundation.
Before Trump entered office, the Biden administration attempted to prevent debt collectors from reporting medical debt to credit agencies as a form of relief – efforts debt collectors fought. The government's legal defense of these rules abruptly ended with the gutting of the CFPB.
'I don't think we want to make a case that these are evil companies because at the end of the day they did increase access for some patients on the net,' said Bai. Instead, Bai views the system, like Stenglein, as 'dysfunctional'.
'We have toxic soil – that's why we're seeing all kinds of outlandish plants grown.'
• This article was amended on 12 June 2025 to correct the processing fee charged by Curae, which was previously stated as 6% for every transaction; and to clarify that while Curae does not enroll patients in hospitals' charity care programs, it helps enroll them in third-party programs to cover costs.
擷取數據時發生錯誤
登入存取你的投資組合
擷取數據時發生錯誤
擷取數據時發生錯誤
擷取數據時發生錯誤
擷取數據時發生錯誤

Try Our AI Features

Explore what Daily8 AI can do for you:

Learn with AIFact CheckingText to SpeechAI Summary

Related Articles

Vogue

25 minutes ago

• Vogue

EMDR: The Therapy Treatment That Miley Cyrus Says Saved Her Life

Anxiety can hinder so much of everyday life, but there are many helpful and safe ways to cope. For Miley Cyrus, she credits a specific type of therapy that helped her with stage fright and what she says also saved her life: EMDR. 'It's so weird because it's like watching a movie in your mind, but it's different than dreaming. You're kind of more in yourself, but still in another place of consciousness that's kind of hard to describe unless you've been in that hypnotic state,' the 32-year-old singer recently said in an interview with The New York Times. EMDR, more formally known as Eye Movement Desensitization and Reprocessing, is a psychotherapy technique that treats trauma-related stress and other mental health issues such as depression, anxiety, panic, grief, loss, and substance disorders. Developed by psychologist Francine Shapiro, PhD, in 1987, it has since been used to help adults (and even children). Cyrus goes on to explain in the interview that her therapist encouraged her to explore different points in her life that matched the anxiety she feels when she would go sing on stage. After finding herself on a mountaintop in a place where she experienced a lot of trauma, she was surrounded by nature and people—her grandma, her mom, her current boyfriend, her as a little child, and even her dog—who have brought her peace and love. When they all grabbed her hand to play Ring Around the Rosie, she came out of that vision feeling renewed. 'I've never had stage fright again,' she says. How does it work? EMDR involves reprocessing traumatic memories or stressful events using bilateral stimulation. Elizabeth Ochoa, PhD, chief psychologist at Mount Sinai-Behavioral Health Center, explains that you'll be asked to recall an emotion, an image, or words that are linked to that traumatic event while a form of bilateral stimulation is being administered by a clinician. The stimulation can include rapid eye movements, during which a person tracks the movements of a finger, ball, or some sort of stimulus with their eyes, tapping, or auditory cues. The goal, Ochoa says, is to reduce distress related to that painful memory. Who is it for? Ochao says that EMDR is perfect for those who are experiencing depression, anxiety, panic, or other emotional distress whenever a traumatic memory is triggered. If this is something that happens frequently enough over a long period of time and it starts to hinder how you live out your day to day life, she says this might be a treatment to consider. The benefits of EMDR Studies show that those who use EMDR can reap the same benefits as those who use years of psychotherapy, just in a shorter amount of time. The idea is that EMDR can help the mind recover from psychological trauma by removing mental blocks that stop the healing, similar to how the body recovers from physical trauma. 'The brain's information processing system naturally moves toward mental health. If the system is blocked or imbalanced by the impact of a disturbing event, the emotional wound festers and can cause intense suffering. Once the block is removed, healing resumes,' writes the EMDR Institute on its site. 'Using the detailed protocols and procedures learned in EMDR training sessions, clinicians help clients activate their natural healing processes.' The downsides of EMDR EMDR can be quite triggering at first. Ochao says that uncomfortable feelings or distressing thoughts, feelings, and even dreams will emerge as you're reprocessing these traumatic events. Those who are not ready to face those painful feelings may want to look for a gentler treatment option. EMDR is not for those who have personality disorders, diagnosed mental illnesses, or severe psychiatric disorders. She adds that this treatment is not suitable for ongoing trauma that is currently happening in your present life. 'In a general sense, for EMDR to be safely utilized, the patient needs to have sufficient emotional coping skills, distress tolerance, and stability to manage the emotional distress that will emerge during treatment safely,' she says. What to Expect During a Session There are eight phases in a single EMDR session. Ochao explains that the initial phase will focus on identifying the memory that is causing all the trauma. The following phase will try to desensitize that memory, using the same bilateral stimulation techniques. Once that memory is neutralized, she says the focus will shift to instilling positive beliefs. The EMDR Institute breaks it down even further like this:

Yahoo

25 minutes ago

• Yahoo

Health insurers vow to speed approval of medical care

UnitedHealthcare , Kaiser Permanente and other major U.S. health insurers say they want to make it faster and easier for patients to obtain care. Health Insurance Plans (AHIP), a trade association that represents the health insurance industry, announced Monday that some of its biggest members are taking steps to streamline "prior authorization" — industry jargon for the process by which health care providers obtain approval from patients' insurance carriers to deliver care. Prior authorization requests can be time-consuming for doctors, resulting in frustrating delays for patients in obtaining essential medical care. According to a survey from the American Medical Medical Association, physicians' offices spend an average of 12 hours per week seeking approval for services from insurers, administrative hurdles that critics say takes time away from providing care. As part of the new agreement, participating insurers have committed to a series of steps they say will speed up the sluggish process. That includes creating a standardized system for submitting prior authorization online, reducing the amount of claims subject to prior authorization and ramping up real-time responses to requests. Such changes are scheduled to take effect in 2026 and 2027. "The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike," AHIP CEO Mike Tuffin said in a statement. "Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system." Shawn Martin, CEO of the American Academy of Family Physicians, said in a statement that the insurance industry initiative is a "step in the right direction," but that the real test will be the impact it has on the experiences of patients and physicians. Dozens of insurers signed onto the commitment, including a number of state Blue Cross and Blue Shield plans and some Medicare and Medicaid plans. In all, AHIP says the joint effort to improve prior authorization could benefit more than 250 million Americans. The signatories include: AmeriHealth Caritas Arkansas Blue Cross and Blue ShieldBlue Cross of IdahoBlue Cross Blue Shield of AlabamaBlue Cross Blue Shield of ArizonaBlue Cross and Blue Shield of HawaiiBlue Cross and Blue Shield of Kansas Blue Cross and Blue Shield of Kansas CityBlue Cross and Blue Shield of LouisianaBlue Cross Blue Shield of MassachusettsBlue Cross Blue Shield of MichiganBlue Cross and Blue Shield of MinnesotaBlue Cross and Blue Shield of NebraskaBlue Cross and Blue Shield of North CarolinaBlue Cross Blue Shield of North DakotaBlue Cross & Blue Shield of Rhode IslandBlue Cross Blue Shield of South CarolinaBlueCross BlueShield of TennesseeBlue Cross Blue Shield of WyomingBlue Shield of CaliforniaCapital Blue CrossCapital District Physicians' Health Plan, Inc. (CDPHP)CareFirst BlueCross BlueShieldCenteneThe Cigna GroupCVS Health AetnaElevance HealthExcellus Blue Cross Blue ShieldGeisinger Health PlanGuideWell Mutual Holding CorporationHealth Care Service CorporationHealthfirst (New York)Highmark Blue Cross Blue Shield of New JerseyHumana Independence Blue CrossIndependent HealthKaiser PermanenteL.A. Care Health PlanMolina HealthcareNeighborhood Health Plan of Rhode IslandPoint32HealthPremera Blue CrossRegence BlueShield, Regence BlueShield of Idaho, Regence BlueCross BlueShield of Oregon, Regence BlueCross BlueShield of Utah, Asuris Northwest Health, BridgeSpan HealthSCAN Health PlanSummaCareUnitedHealthcare Wellmark Blue Cross and Blue Shield Kidney dialysis industry accused of maximizing profits over patients Pentagon officials reveal new details about U.S. strikes on Iran's nuclear sites Netanyahu reacts to U.S. strikes on Iranian nuclear sites

Bloomberg

27 minutes ago

• Bloomberg

India-US Eye Trade Deal by July Though Challenges Remain

India and the US are keen to clinch an early trade deal before the July 9 deadline, when higher US tariffs are set to kick in, but challenges remain, according to an official familiar with the matter. Sectors including agriculture are proving to be one of the toughest parts of the negotiations, the person told reporters on Monday in New Delhi, asking not to be identified as the negotiations are ongoing.