Why DueWell
Between the last statement and the collection agency there’s a 60-to-120-day stretch that no one in a provider’s stack is built for. That’s where the money is, and that’s all we do.
For decades the collection agency’s real tool was the credit report. Two things happened to it.
Providers, billing vendors, and collection agencies may not furnish medical debt to credit bureaus; bureaus may not report it; lenders may not use it. A medical debt that is reported anyway becomes void and unenforceable. Since July 1, 2025, medical-debt contracts must disclose this.
Since 2022–23, Equifax, Experian, and TransUnion voluntarily remove paid medical debt, never report medical collections under $500, and wait 365 days before any medical collection appears. The CFPB’s 2025 rule to remove medical debt entirely was vacated by a federal court in July 2025 — but the voluntary rules stand, and 15+ states have passed their own bans.
What that did to the model
For a typical practice balance — a few hundred dollars — the credit-report threat effectively no longer exists, and in California it is illegal to make. An agency’s remaining tools are letters and calls from a stranger, at 25–40% of recovery. First-party outreach now holds the only lever left: the relationship. The economics of the hand-off have quietly broken, and most practices haven’t re-examined the default.
Sources: Cal. SB 1061 (Civ. Code §1785.27 et seq.; CMA and CAP physician guidance); CFPB Medical Debt Rule, 90 Fed. Reg. (Jan. 2025), vacated in Cornerstone Credit Union League v. CFPB (E.D. Tex. July 11, 2025); nationwide consumer reporting agency joint announcements, 2022–2023; NCLC state-law tracker.
Before the evidence
The hand-off, the alternative, the patient’s side of it, what one practice measured a year later, and how the fee works. Narrated, captioned, no sales call required.
Everyone in patient billing publishes a lift percentage. We publish recovery by how old the balance was when outreach began, within a stated window, from the ledger. It’s the number a CFO can check.
| Age at placement | Window | Recovered |
|---|---|---|
| 61–90 days | within 90 days | 62.8% |
| 91–120 days | within 90 days | 46.9% |
| 121–180 days | within 180 days | 30.8% |
| 180+ days | within 180 days | 10.5% |
| Agency benchmark | lifetime of placement | 17–21% |
Performance figures are single-site results from a founder-affiliated diagnostic imaging practice; observational data, no control group. Agency benchmarks: ACA International recovery data as reproduced in trade sources; contingency ranges are industry-standard.
Patients who pay, pay fast once reached: median days from first outreach to cash is 5–12 days in every bucket up to 180 days. Past 180 days recovery falls to about 10% — deep-aged debt is hard for everyone, which is exactly why the 60–180-day window matters.
March–August 2026 on DueWell against March–August 2025 on the vendor it replaced — same practice, same calendar months, same cash-event rules applied to both ledgers.
| Month | Prior vendor 2025 | DueWell 2026 | Paying patients 2025 | Paying patients 2026 |
|---|---|---|---|---|
| Mar | $93,451 | $168,404 | 597 | 931 |
| Apr | $96,185 | $157,017 | 618 | 932 |
| May | $77,112 | $136,834 | 556 | 777 |
| Jun | $71,204 | $134,514 | 487 | 821 |
| Jul | $76,511 | $131,698 | 532 | 854 |
| Aug | $67,786 | $130,669 | 522 | 777 |
| Six months | $482,249 | $859,136 | 3,312 | 5,092 |
| Age at engagement | Prior vendor | DueWell | Difference |
|---|---|---|---|
| 31–60 days | 55.2% | 81.3% | 26.1 pts |
| 61–90 days | 47.6% | 62.8% | 15.2 pts |
| 91–120 days | 26.8% | 46.9% | 20.1 pts |
| 121–180 days | 30.9% | 29.3% | -1.6 pts |
What this does not say: that patients pay sooner after their visit. Measured from the date of service, DueWell’s time to cash is longer than the prior vendor’s — because it recovers balances six to twenty-four months old that the prior vendor never worked. The clock that isolates the platform is the one from first message to cash, and it sits at 15 days.
Founder-affiliated diagnostic imaging practice, single site. Platform: production ledger, read-only extraction, data as of Sep 20, 2026. Prior vendor: its raw account export through Dec 2025, recomputed under the same cash-event rules and reconciled to its published lifetime card cash ($1,135,069). The platform's days from date of service to cash are longer than the prior vendor's because it works far older balances. The cash increase cannot be separated from placement volume or deductible mix using collections data alone. Observational, no control group.
Collecting a patient balance by text, email, or AI voice is regulated the same way whether the practice does it itself or a stranger does. Being the provider changes two things: what consent already exists, and how the message can sound.
A patient who gave the practice their number at intake consented to be contacted about that visit's balance. The provider holds that consent; an agency has to inherit it. DueWell records consent per patient, per channel, with its source and date — and contacts nobody by default.
A STOP by text, a request on a call, or a note to the front desk revokes consent across every channel at once, with an audit trail — built ahead of the FCC's 2027 revoke-all rule, not after it.
The FCC treats AI voices as “artificial” under the TCPA, and California requires disclosure. The voice agent dials only patients with explicit voice consent, says what it is, verifies date of birth before it says a balance, and never takes a card.
Messages come from the practice, in its name and its tone. The federal debt-collector script doesn't attach to a provider collecting its own balances — but frequency, hours, and content are held to collector standards anyway, because California applies them to creditors too.
DueWell does not furnish anything to a credit bureau. In California that is now the law; everywhere else it is what keeps the patient relationship intact.
Each client runs in its own deployment under its own BAA. Billing outreach is a permitted payment use; no patient identifiers travel to the payment processor; every access is logged.
First-party changes who is speaking and what consent already exists. It does not change the rules. None of this is legal advice; which rules reach your practice depends on your state and on how your intake paperwork captures consent — we will walk through both with your counsel before go-live.
FCC Declaratory Ruling on AI-generated voices under the TCPA (Feb. 8, 2024); FCC 2015 TCPA Omnibus Order (health-care exemption excludes billing and debt-collection content); FCC consent-revocation rules (2024; revoke-all effective Jan. 2027); Cal. Civ. Code §1788 et seq. (Rosenthal Act); Cal. AB 2905 (AI voice disclosure, 2025); Cal. SB 1061 (2025); 45 C.F.R. §164.506 (HIPAA payment uses).
| Dimension | DueWell — first-party | Collection agency — third-party |
|---|---|---|
| Who the patient hears from | Their doctor’s office. Same name, same number, same tone as the visit. | A stranger. A different company name on the letter and caller ID. |
| When it starts | Day 60, while the balance is still fresh and the patient still remembers the visit. | Day 90–180, after the account has already gone cold. |
| What it collects | Roughly 30–60% of aged dollars, bucket-dependent, within 90–180 days. | ~17–21% of placed medical debt, over the life of the placement. |
| What it costs | Platform fee + 6% of what’s actually recovered on aged accounts. | 25–40% of whatever it recovers. |
| The provider nets | About 30 cents per aged dollar placed. | 10–16 cents per aged dollar placed. |
| Leverage | Convenience — text-to-pay, plans, card-on-file, a portal — and the relationship. | Historically, the threat of a credit report. That lever is largely gone. |
| The relationship | Intact. The patient paid the practice. | Damaged. The patient was sent to collections by the practice. |
Performance figures are single-site results from a founder-affiliated diagnostic imaging practice; observational data, no control group. Agency benchmarks: ACA International recovery data as reproduced in trade sources; contingency ranges are industry-standard.
They could try. Structurally, they don’t — and the reasons are about incentives and evidence, not features.
Revenue-cycle vendors charge 4–7% of all collections. First statements are where their money is; a practice’s aged patient balances are a rounding error to them. Nobody builds their best product for a rounding error.
Sending aged accounts to collections closes the file and, for many vendors, carries a referral or revenue share. A tool that makes in-house recovery work competes with their own back end.
Front-of-funnel platforms optimize time-to-first-payment: digital statements, estimates, reminders. A 120-day-old balance needs different messaging, cadence, plan structures, and a voice that sounds like the office.
Competitors publish unscoped lift percentages. We publish ledger-verified recovery by age-at-placement and observation window — a number a CFO can check. Pricing on recovered aged dollars only works if you’re confident in that number.
Each client is a separate deployment with its own business associate agreement and no shared data plane. That’s the security-review answer a multi-tenant enterprise platform can’t give a ten-location group.
The founder runs an outpatient practice and built this on its real ledger and real patients. Practice owners buy from operators.
The honest version
A well-funded front-of-funnel vendor could add an “aged AR” module any quarter. What they can’t ship quickly is the evidence, pricing that depends on it, and a founder who is the buyer. Outsourced-RCM firms that bundle self-pay outreach aren’t the target either — DueWell sells to providers that run their own billing and currently hand aged balances to an agency.
Imaging is the beachhead — high patient-pay share, large aged books, and the founder’s own network. The platform underneath is specialty-agnostic: it moves receivables, statements, and payments.
Sources: Definitive Healthcare physician-group data, January 2025; Physicians Advocacy Institute / Avalere practice-ownership study, January 2026; Marketdata Enterprises, U.S. Diagnostic Imaging Centers: An Industry Analysis, September 2025.
Who buys. Any provider that bills its own patients and hands aged balances to an agency — imaging, orthopedics, GI, dermatology, urgent care, dental, physical therapy, hospitals and health systems. The buyer is the practice CEO, administrator, or billing director.
Who doesn’t. Practices that have outsourced revenue cycle wholesale already have self-pay outreach bundled in. We qualify for this on the first call.
Bucket totals only — no patient data. You’ll get the same analysis as the calculator, on your real book.