Hospitals and medical providers are increasingly requiring patients to pay for services in advance, a significant shift from the traditional model where bills were sent after treatment. This trend is exemplified by cases like Heather Miconi, who needs to pay $2,000 upfront for her daughter's adenoid and tonsil surgery at Merritt Island Surgery Center, or the procedure will be postponed. Similarly, Thomas Zordani was asked for a $5,000 preservice deposit by Mayo Clinic, despite having insurance with out-of-network benefits, a request that differed significantly from an earlier $565 cost estimate.
This push for upfront payments, often termed "point-of-service payments" or "preservice deposits," is a response to rising patient deductibles and increasing uncollected medical debt. The average family deductible for employer-sponsored coverage is $3,762 per person. Hospitals aim to collect a larger portion of what patients owe upfront, with one estimate suggesting they now collect about 25% of the expected patient responsibility, up from around 15% previously. This practice shifts more financial burden onto patients, essentially asking them to "self-insure" against high costs.
Major medical institutions like Johns Hopkins Medicine and MD Anderson in Houston have policies requiring prepayment for non-emergency care or initial deposits for self-paying cancer patients. While this helps hospitals mitigate the risk of unpaid bills, it creates significant challenges for patients struggling with high out-of-pocket costs. Industry experts, such as Richard Gundling of the Healthcare Financial Management Association and Chip Kahn of KFF, highlight that this trend makes healthcare access harder for both providers and patients, emphasizing the broader issue of how to maintain access when more patients cannot absorb high out-of-pocket costs.
There are some legal protections, notably that hospitals accepting federal Medicare financing cannot demand upfront payment for emergency stabilization. However, for non-emergency care, patients often face demands for substantial payments. Overpayments can occur if actual costs are lower than estimated, or if other payments count towards deductibles already partially covered by a patient's prepayment. The speed of refunds for overpayments varies, with only a few states, like Florida, mandating reimbursement within a specific timeframe (30 days).
