Picture a Tuesday evening for a typical family bill-payer. She’s 48. Her son had an urgent care visit for a sprained wrist last month. Her mother had outpatient imaging at the same community hospital two weeks later. Her husband had labs drawn in between.
Three visits, three statements, each with its own account number, due date and amount. She wants to pay. She’s just not sure what she owes, what’s already been paid, or whether the letter on the counter is new or a reminder.
Ask a community hospital business office why patients don’t respond to text or email billing, and you’ll often hear the same answer: our patients are older, and they want paper. For many patients, that’s true. But it misses who is actually opening the bill. More and more often, it’s someone like her: an adult daughter, a spouse or a parent handling the paperwork on someone else’s behalf.
The family is doing the paperwork
Family caregiving isn’t a niche situation anymore. About 63 million Americans now care for a family member, roughly one in four adults, and that number has grown 45% in a decade (AARP and National Alliance for Caregiving, 2025).
A lot of that care happens at the kitchen table, not the bedside. In the same study, 58% of caregivers said they help manage finances, “such as paying bills or filling out insurance claims,” up from 54% in 2020. Nearly two-thirds (64%) talk directly with the care recipient’s providers (Caregiving in the US 2025).
That responsibility shows up in household debt, too. Among adults carrying health care debt, 12% say it came from someone else’s care, and another 34% say it came from a mix of their own care and someone else’s (KFF Health Care Debt Survey, 2022). For nearly half of people with medical debt, the bill wasn’t only theirs.
Community hospitals feel this more
Community hospitals often care for several generations of the same family. One household might show up in your ED, your outpatient clinic and your lab within a few months.
Your patient mix also makes it more likely that someone else is paying. Medicare covered 53% of discharges at rural community hospitals in 2023, compared with 45% at urban ones (KFF, 2025). In emergency departments nationally, about one in five visits in 2022 (21.2%) was by a patient 65 or older, and another 17.0% were children under 15 (CDC NHAMCS, 2022). An older patient may lean on an adult child to sort out the statement. A child’s bill goes to a parent or guardian.
The formal path for caregivers is barely used
Most hospitals do offer caregivers an official way in, usually a proxy account on the patient portal. The trouble is that few families use it, and hospital staff don’t always point them to it.
When researchers posed as caregivers and contacted 102 U.S. hospitals in 2018, 68% offered proxy portal accounts for adult patients. But 45% of the staff they spoke with suggested using the patient’s own login instead (JAMA Internal Medicine, 2020). Use stays low on the family side too. In 2017 data on older adults with a disability, only 15% had a caregiver using the portal on their behalf, and just 2% used it together with a caregiver (Innovation in Aging, 2022).
In practice, the person paying the bill is often working around the system rather than through it: borrowing a password, calling the business office, or waiting for a paper statement to be passed along.
What goes wrong when billing ignores the payer
When statements go to the patient instead of the person who pays, a few things happen:
- Statements reach the wrong person. A bill addressed to a 16-year-old sits unopened. A bill for an elderly parent goes to an address they no longer manage.
- Your phones ring. The payer calls to ask which bill is which, whether they’ve already paid, and why two letters arrived the same week.
- Balances age. Every confusing statement adds days before payment, and some of those balances drift toward bad debt.
None of this is the family being unwilling to pay. It’s the billing experience making it hard. And with a lean business office, every “which bill is this?” call is time not spent on denials, follow-up or patients who need real help.
How this impacts your billing workflow
If the person paying is often not the patient, your billing should be built to reach them. Three changes you can make:
- Capture the payer’s mobile number at registration, not just the patient’s.
- Look at the responsible party’s payment preference, not just the patient’s. Digital first is faster.
- Let them pay with no login required, using information they already have.
The more friction, the less likely you are to get paid
Every extra step is a friction point: finding the statement ID, logging in, going to get a wallet. Each one can turn an engaged payer into a disengaged one.
84% of all bills paid through PayGround are paid digitally. There’s no login; payers use information they already have. While they’re engaged, they can do what they can: pay in full, set up a payment plan, finance the balance, or pay what they can today. Combine that with a wide range of payment methods, and we convert an engaged payer into a payment nearly 65% of the time.
“PayGround made paying a hospital bill as easy as paying any other bill. Our patients get their balance by text, pay in a few taps, and our team spends far less time on the phone answering billing questions.”
— Edward Din, Senior Director of Patient Access, Kern Medical Center
See it for yourself
Visit our patient experience page to experience a PayGround bill the way a family member would get it, or book time with us to see how it works with your EHR.