ISSUE 10 · 8 MIN
Patrick Haig and Ian Sefferman built Goodbill to pull the itemized bill from the hospital's own patient portal, let A.I., coders, and clinicians flag the overcharges, and negotiate the balance down for 20% of what it saves, never more than $1,000. Its site reports an average 30% reduction on hospital claims across 13K+ employers and 600K+ members. The terrain was open because a hospital bill is a list price that almost nobody pays: HCA's own 10-K puts its patient care costs at 9.6% of what it charges.
The job used to belong to a medical billing advocate, who would request the itemized bill on your behalf, read every line against the medical record, find the lab drawn once and billed twice, and phone the billing office until someone agreed to a lower number, for a share of whatever came off. Goodbill does the first two parts with software and keeps the third part human.
A patient starts at goodbill.com/patients. Goodbill retrieves the itemized bill from the hospital, the patient connects the hospital's patient portal so it can read the medical record (the company says it is connected to 2,500+ hospitals for record access), and then, in the homepage's words, "A.I., coders, and clinicians flag overcharges based on provider notes." Its medical coding and billing experts negotiate with the hospital. The patient pays 20% of the money saved, with no upfront cost, nothing at all if there is no saving, and never more than $1,000 however large the reduction. The FAQ says savings usually run 20-60% and have reached 95%.
The same review is sold to self-funded employer health plans, where Goodbill reports 8% average savings on annual plan spend and screens claims for the hospital's own financial assistance policy through 3,500+ hospital connections. When the company raised nearly $2 million in March 2024, bringing its total to $5.3 million, it said roughly one in every two claims it reviews contains an overcharge.
Hospital bill prices come from the chargemaster, the hospital's list of gross charges, which has no fixed relationship to cost. Ge Bai and Gerard Anderson found in Health Affairs in 2015 that the typical US hospital charged 3.4 times the Medicare-allowable cost in 2012. HCA Healthcare puts its own number in its 10-K: a cost-to-charges ratio of 9.6% for 2025, meaning care cost 9.6 cents of every dollar billed, so its list prices ran about 10 times its cost. Almost nobody pays the list price: RAND found that employers and private insurers paid 247% of Medicare rates in 2018, and the chargemaster is a price only uninsured and out-of-network patients are ever asked to pay in full, which is why a 30% discount still remains after the care is delivered.
Advocates collect the toll on a contingency basis. Resolve publishes its schedule: for bills of $5,000 to $15,000, a $250 deposit plus 25% of the savings; for $15,000 to $200,000, a $499 deposit plus 10%. Its counter reads $55,235,678 saved to date, but the schedule starts at $5,000, so a smaller bill has no advocate. Undue Medical Debt buys hospital debt with donations, says each $1 erases about $100 of debt, a penny on the dollar, and by June 2025 had abolished $20.3 billion of it. KFF puts the pool at at least $220 billion of medical debt.
The toll existed because the price was secret. 45 CFR Part 180, in force since 1 January 2021, requires a free machine-readable file of every standard charge, including each payer's negotiated charge and the discounted cash price, and under the CY2026 rule the file must show the median amount actually paid rather than an estimate, with enforcement from 1 April 2026. PatientRightsAdvocate reported on September 10, 2026, that 49% of the 2,000 hospitals it reviewed were complying, up from 21%. What changed is that the file exists and a model can read a medical record against a bill in seconds, the labor the advocate was paid for.
The incumbent's latest move was to argue the file is the wrong tool. In testimony on June 10, 2026, the American Hospital Association called the proposed formats "transparency in name only." The hospitals' collection leverage also survived: the CFPB rule keeping medical debt off credit reports was vacated by a Texas federal court on July 11, 2025.
The price advantage is the gap between the list price and what the hospital already accepts from everyone else, a gap HCA's own 10-K puts at about 10 to 1, and the hospital's own price file now has to publish.
A mention here is listed, never sold.
LISTED · HOSPITAL BILL REVIEW AND NEGOTIATION
Goodbill
Retrieves the itemized bill and the medical record through the hospital's patient portal, flags overcharges with what the homepage calls "A.I., coders, and clinicians," and has its billing experts negotiate. Patients pay 20% of the saving, capped at $1,000, nothing if there is no saving; the FAQ reports savings of 20-60%. Employer plans get the same review plus financial assistance screening, with a reported 8% average saving on plan spend and a 30% average reduction on hospital claims. Founders Patrick Haig and Ian Sefferman; the about page lists 13K+ employers and 600K+ members.
LISTED · CONSUMER BILL DEFENSE APP
CareRoute
A consumer app from Healtheja, Inc. with two parts: Bill Defense, which disputes and negotiates an existing medical bill, and pre-care tools for cost estimates and network checks. The site says Bill Defense wins a reduction in 64% of cases and saves patients about $1,500 on average when it wins; it charges a percentage-of-savings fee with a cap and nothing otherwise, and is rated 4.9 stars by 2k+ users. Founders: Jag Kondru, chief executive, formerly at Goldman Sachs and Amazon, and Prathima Madda, a physician and chief medical officer.
Reach them · careroute.ai/about
LISTED · FLAT FEE BILL NEGOTIATION
mediloop
Refuses the contingency model. Its pricing page lists a $49 action plan in which a specialist reviews the bill and tells you what to do, a $129 pay-per-bill service in which the specialist negotiates one bill with a money-back guarantee, and a $499 annual plan covering up to six household bills, and says competitors typically charge 10-25% commission. The homepage cites a 2024 JAMA Health Forum finding that 62% of people who push back on a medical bill get the price dropped. Founded by Flavia, who gives only a first name.
Reach them · mediloop.ai
LISTED · FREE CHARITY CARE FILINGS
Dollar For
A nonprofit, founded by Jared Walker, that files hospital financial assistance applications for patients at no charge; the applications nonprofit hospitals must offer under IRS section 501(r). Its site gives the example that a family of four earning less than $100,000 a year will qualify. Its origin story marks over $50,000,000 of medical debt relieved, and its research says hospitals fail to provide at least $14 billion a year in charity care they owe, instead recording the bills as bad debt.
Reach them · @dollarfor
Take one bill of $10,000, an assumption that falls inside Resolve's lowest published tier, and run it three ways. Goodbill's reported 30% average reduction takes $3,000 off; its fee is 20% of that, $600, and the patient keeps $2,400. That 20% is a take rate, the share of the money passing through that the service keeps, and it is charged on the savings, not on the bill. Resolve on the same bill charges the $250 deposit plus 25% of the $3,000, which is $1,000; it's the published minimum, and the patient keeps $2,000. Mediloop charges $129 flat for the same reduction, and the patient keeps $2,871.
Now take the hospital's side of the same bill. At HCA's 9.6% cost-to-charges ratio, the $10,000 bill represents about $960 of patient care cost. After the 30% cut, the hospital still bills $7,000, which is 7.3 times its cost. The negotiation moves the patient toward the insurer's price without moving the hospital below what it already collects from everyone else, which is why hospitals concede.
The cap changes the picture on big bills. On a $100,000 bill, a 30% reduction is $30,000; Goodbill's fee stops at $1,000, a 3.3% take rate, while Resolve's tier for that size charges $499 plus 10%, or $3,499. Goodbill is choosing to forgo fee income on the largest bills, which suggests the patient product brings customers in and the employer plan, priced at 8% of annual plan spend, is the business.
What one review costs Goodbill is not published, so watch the cost to serve, the fully loaded cost of delivering one unit of the service. The coder and clinician review is the expensive part, and the homepage's own order, A.I. first, then coders and clinicians, is the order in which that cost has to fall. The billing office has a reason to settle: every day a bill goes unpaid adds to the hospital's days sales outstanding, the average number of days it takes to collect what it has billed, and the bill that ages longest is the one Undue Medical Debt buys for a penny.
For this to make money at scale, the coder's time per bill has to fall toward minutes, the portal connections have to keep working across thousands of hospitals, and the billing office has to settle by letter rather than by phone, because a $600 fee cannot pay for hours on hold.
Build for the bill Resolve will not take. Its schedule starts at $5,000, and Mediloop's $129 flat fee is the published reference price below that, so the weekend version is a flat fee review for bills under $5,000 that ends in one of two letters: a negotiation letter that cites the hospital's own discounted cash price and payer-negotiated rates, or a financial assistance application under 501(r) at a nonprofit hospital, the assistance Dollar For says hospitals fail to provide, at least $14 billion a year.
The one integration that matters is the hospital's machine-readable standard charge file under 45 CFR Part 180: pull it, index it by CPT and revenue code, and every line on the itemized bill can be laid next to the gross charge, the cash price, and the rate the hospital already accepts from insurers, with the Medicare rate as the floor. No payment rail is needed beyond a card for the flat fee, and never charge on the savings, because a fee on a discount the hospital would have given anyone who asked is the practice this build replaces.
The first customer to call is the benefits administrator at a self-funded employer, because Goodbill's own numbers, 13K+ employers and 8% of plan spend, say the employer is who pays for this at scale.
nathan8823/fairbill is a playbook, written as an AGENTS.md skill for a coding agent, that takes an itemized hospital bill from a photo or PDF, audits it, benchmarks each charge against Medicare rates and the hospital's own published price file, screens for 501(r) charity care eligibility, and drafts the negotiation emails, certified letters, and phone scripts. One star, MIT license, last push July 13, 2026. It is worth an hour because it is the whole job in one file: read it once, and you know exactly what a 20% contingency fee is buying, and where the code has to go to make it run without the coder.
The fraud in this build is in the baseline. A contingency negotiator earns its fee on "savings," and the savings are measured against the list price, a number the hospital never expected to collect. HCA's own 10-K says the list is about 10 times cost, and a nonprofit hospital's financial assistance policy, required under 501(r), may already oblige it to waive the bill for a patient below the income line. So a negotiator can bill 20% of a reduction the hospital would have granted anyone who asked in writing.
The one control: measure every saving against the discounted cash price and the payer-negotiated rates in the hospital's own machine-readable file, and against its published financial assistance thresholds, and refuse the fee on any part of the reduction those documents already provided for. A service holding portal credentials to thousands of hospitals also holds access to medical records, so that access has to be scoped to one bill and revocable by the patient.
FLINT Scout runs that authorization check on every agent spend for a penny.
PASS IT ON
A hospital bill sits in a friend's drawer, unopened since spring, and a collection notice is on its way. This tells them what that care cost the hospital.
NEXT ISSUE
Agents that appeal property taxes. Ownwell charges a share of the savings it wins, 25% in its own worked example, its customers who win save $774 a year on average, and it says 74% of homeowners have never appealed. Who sets the assessed value, why the appeal window is so short, and what an agent that reads the comparable sales keeps.
SOURCES
Goodbill homepage stats · Goodbill patients page · Goodbill FAQ fee and savings · Goodbill about page · Goodbill help center fee cap · Goodbill funding announcement · HCA Healthcare 2025 10-K · Johns Hopkins Bai and Anderson summary · RAND hospital price study · Resolve fee schedule · KFF medical debt burden · Undue Medical Debt donation ratio · Undue Medical Debt milestone · eCFR 45 CFR Part 180 · Federal Register 2019 final rule · CMS CY2026 transparency fact sheet · PatientRightsAdvocate compliance report · AHA House testimony · CFPB medical debt rule status · IRS section 501(r)(4) · Dollar For charity care research · Dollar For homepage · Dollar For origin story · CareRoute site · CareRoute founders · mediloop pricing · mediloop homepage · fairbill repository · Ownwell pricing · Ownwell appeal statistics
