Healthcare Billing Has Improved, but Affordability Is Now the Real Friction Point

Healthcare billing is no longer where it was even a few years ago. Bills are more digital, easier to read and more likely to reach patients through their preferred channels. Cedar’s 2026 Healthcare Financial Experience Study reports that 90% of patients receive bills through preferred channels, 78% review bills within 24 hours, and 76% say they have convenient access to payment options. 

But convenience is no longer the central problem.

The deeper challenge, according to Cedar, is that patient financial risk has shifted faster than billing systems have adapted. Nearly 40% of collectible dollars on Cedar’s platform now come from uninsured patients, up 54% in three years. The report is based on a December 2025 survey of 4,150 U.S. adults and analysis of 1.5 billion patient interactions across Cedar partners. 

For physicians and healthcare leaders in Los Angeles, that finding should land with urgency. In a market already grappling with coverage instability, rising out-of-pocket exposure and strain on the healthcare safety net, the report points to a widening gap between how providers bill and what patients are realistically able to handle. 

It is worth noting that Cedar is a healthcare billing vendor with a commercial interest in highlighting shortcomings in the patient financial experience. This is company-conducted research, not an independent academic study. Even so, its central themes align with broader national affordability trends. KFF reports that nearly half of U.S. adults say it is difficult to afford healthcare costs, and cites Congressional Budget Office estimates that the 2025 federal reconciliation law will increase the number of uninsured people by 10 million by 2034. 

Cedar’s central argument is straightforward: many billing systems were designed for financially stable patients, while the fastest-growing share of collectible revenue now comes from patients whose coverage and financial circumstances are far more volatile. The report argues that insurance status and traditional propensity-to-pay models often tell providers very little about a patient’s actual capacity or willingness to pay. 

That has direct implications for medical groups, hospitals and revenue cycle teams. Thirty percent of patients surveyed said the payment options presented to them were unaffordable. Just as notably, Cedar found that four in ten patients who view current payment options as unaffordable earn $100,000 or more. Even among commercially insured patients, one in four reported difficulty paying medical bills. 

The report also pushes back on a familiar operational assumption: that better reminders alone will improve collections. Cedar found that the issue is not simply whether a bill reaches the patient at the right time or in the right channel, but whether the outreach reflects the patient’s actual barrier to payment. While 20% of patients overall said billing reminders arrive at inconvenient times, that figure rose to 45% among at-risk patients. At-risk patients were also three times more likely than high-capacity patients to report untimely reminders. 

In practical terms, that means a generic reminder may work for a patient with a manageable balance, but it is far less likely to move someone who needs a lower monthly payment, clearer bill explanations, financial assistance information or help securing coverage. Cedar specifically found that uninsured patients often do not need another nudge to pay. They need a path to coverage. Rural patients, meanwhile, reported more friction across the financial journey, including affordability and understanding. 

Another notable finding is how quickly patients are turning to AI for help. Cedar says half of surveyed patients already use AI tools to interpret medical bills or resolve billing questions, often after hours when billing offices are closed. Whether that trend proves lasting or transitional, it signals that patients are increasingly seeking always-available support when the financial side of care becomes too confusing to navigate alone. 

For Los Angeles physicians, the broader takeaway extends beyond revenue cycle optimization. The financial experience is increasingly part of the care experience itself. When patients are confused, overwhelmed or unable to act on the options in front of them, the consequence is not just slower collections. It can mean delayed care, medical debt and additional strain on already burdened practices and systems. National affordability data shows those pressures are not hypothetical. They are already shaping how patients engage with care. 

As coverage disruptions continue and out-of-pocket responsibility rises, this report suggests providers may need to think about billing less as a back-office transaction and more as a front-line patient engagement strategy. For practices across Los Angeles County, the organizations best positioned for what comes next may be the ones that pair operational efficiency with more personalized, context-aware financial support.