AI Patient Billing Mapping Markets: Orchestrating Workflows and Improving Patient Experience
This is part of Elion’s weekly market map series where we break down critical vendor categories and the key players in them. For more, become a member and sign up for our email here.
High-deductible health plans aren't yet a majority (just over one in four covered workers carry an HDHP), but rising deductibles across all plan types mean patients now shoulder a historically high share of costs. Meanwhile, studies show roughly two-thirds of low-dollar patient balances go unpaid. Increasing patient responsibility combined with low patient payment rates are forcing financial leaders to get creative in adopting technology to help maximize revenue while maintaining the patient experience.
How Does Patient Billing Work?
Patient billing involves a series of complex workflows. Operations teams work across pre-service financial counseling (including cost estimates, payment options, and financial assistance programs) and post-service billing, statements, and payment plans.
For outstanding balances, health systems then rely on either internal or outsourced specialized patient financial services units to handle payment plan negotiations and advanced outreach, followed by collections agencies for accounts 120-plus days past due.
This operating environment, which spans multiple internal and outsourced teams across both pre- and post-service workflows, creates several challenges:
Complex, Confusing Bills: Patients often receive multiple, uncoordinated bills from different entities for a single episode of care.
Limited Payment Options: Rigid payment terms that don't account for individual financial circumstances.
Poor Communication: Traditional outreach methods that fail to engage patients effectively.
Delayed Intervention: Financial counseling and support options often come too late in the process.
Modern AI solutions are being embedded throughout this workflow, from pre-service patient engagement to post-service collections. Rather than operating as standalone tools, these solutions integrate deeply with existing revenue cycle operations to enhance efficiency and outcomes.
AI Patient Billing Market Landscape
A decade ago, merely accepting online payments might've been viewed as innovative. Today's platforms are far more sophisticated, leveraging AI across multiple patient touch-points in the billing and collection experience. These new solutions modernize patient billing through: AI-generated bills or explanation letters, AI agents to automate patient interactions both over phone and via chat interfaces, optimized payment scheduling and reminders, and integration of more patient data in order to provide discounts, payment schedules, and other financial support for patients.
The current solution landscape generally falls into two categories:
Digital Patient Engagement and Collections Platforms: These solutions wrap an AI layer around legacy billing processes to nudge patients toward self‑service payment, offload call‑center volume, and surface the right account‑level next action. Some examples include:
Cedar: End‑to‑end “patient financial platform” with unified portal, embedded price‑estimates and a new Twilio‑powered AI voice agent that deflects inbound billing calls.
Collectly Billie: a 24/7 generative‑AI conversational agent that automates responses to routine billing inquiries and processes patient payments.
Ecton: newer entrant (launched 2024) focused on using AI to automate patient financial conversations, from payment plan negotiations to billing inquiries.
Patient Financing and Affordability Solutions: These platforms aim to offer innovative approaches to healthcare affordability. Examples include:
ClearBalance: Bank‑sponsored revolving credit program kept on provider balance sheet.
PayZen: Provider is paid up‑front; AI underwrites each account and offers personalized, interest‑free terms (≤60 months).
AI Agents and the Future
AI agents dominate the current tech hype cycle, and patient billing applications are no exception. Across all categories, we’re seeing agentic AI mature in two key modalities: workflow agents and voice AI. Within these modalities, different strategic approaches to adoption are emerging: domain-specific solutions that offer targeted agent capabilities versus general “agent platforms” that tackle many disparate use-cases.
Cedar is an example of the former. It’s a patient financial experience platform adding an agentic product, Kora, to handle routine billing inquiries and patient-facing tasks. In contrast, voice agent platforms, like Infinitus, represent a different approach, handling a broader range of use-cases across patient, provider, and payer calls. We’re eager to see whether pilots from early adopters will prove these solutions can deliver the cost savings, employee productivity, and improved experiences for patients and providers that they promise.