Charity Care and Financial Assistance: The Savings Most Plans Miss

The eligibility gap

Non-profit hospitals must offer financial assistance, but eligibility checks rarely happen during claim intake.

For self-insured employers, missed screenings mean overpaying on members who qualify for reductions tied to income and family size.

Signals that unlock discounts

Look for structured and unstructured cues to triage members for assistance:

• Household income bands versus local FPL thresholds.
• Household size, dependents, and recent employment changes.
• Diagnosis/treatment types that often trigger high balances (oncology, NICU, complex surgical).
• Provider type: non-profit facilities are obligated to screen and disclose policies.

Make it automatic for members

Embed screening into pre-pay review so members don’t shoulder paperwork alone:

• Auto-check claims against hospital assistance policies and generate a short list of required documents.
• Pre-fill income attestations and send secure links for members to sign.
• Track provider responses and escalate if assistance is delayed past policy timelines.

Expected impact

Across self-insured groups, we see $800–$1,500 average per approved case when applied pre-pay.

Reducing member friction improves satisfaction scores while lowering bad debt risk for providers.

How CodaHx surfaces assistance cases

We blend pricing files, eligibility, and hospital policy data to flag likely assistance cases automatically.

Members receive a guided intake; employers and TPAs see status and savings per case in the dashboard.