More Hospitals and Doctors Are Asking for Upfront Payment: What to Know

More hospitals and doctors are collecting prepayments for non-emergency care, leaving patients with higher out-of-pocket costs and deterring them from obtaining essential care, according to a 2026 survey.

Nearly 92 percent of providers either encourage payment, require it, or collect a payment method during the estimate process, according to the survey conducted by PayZen, a healthcare financing company, and the Healthcare Financial Management Association. A year ago, the number was 81 percent.

Prepayment is what the patient pays for the service before arriving for their appointment. Providers reach out to patients, sometimes days in advance, to provide a cost estimate and request deductibles, coinsurance, and copays.

Hospitals may ask patients to make payments before surgeries, CT scans, echocardiograms, sleep studies, and labor or delivery, according to Major Health Partners’ billing and collections policy.

Some providers, such as Wills Memorial Hospital in Washington, Georgia, state that they may deny non-emergency care if patients have an unresolved charge on their account.

Here is what we know about the spike in prepayment and its effect on patients.

Collecting Upfront

Hospitals have adopted upfront payment policies to reduce bad debts and the cost of collection services, according to MD Clarity, a revenue solution company.

“Every dollar you collect upfront is one you don’t have to spend time and resources collecting after the fact,” MD Clarity said in an October 2023 report.

Collecting upfront payment can let patients know what they’ll owe before receiving services and enable them to make informed decisions, according to MD Clarity.

“Patients who can’t afford a service can look into other options or financing to avoid unpaid bills,” the company said.

As more providers ask for a deposit before service, the amounts they request are also growing. Patients paid an average of 20 percent of their bills upfront in 2025, up from 16 percent the previous year, according to PayZen.

The Emergency Medical Treatment and Labor Act requires hospitals to provide emergency medical treatment regardless of an individual’s ability to pay. But for non-emergency care, federal law does not prohibit hospitals from requesting pre-service payments.

Nonpayment Still Rising

The amount patients pay at the time of service also increased. It was nearly 23 percent in the first quarter of 2025 and rose to almost 25 percent in the same period of 2026, according to Kodiak Solution, a healthcare technology and financial services company, in a June report based on data from 2,300 hospitals.

However, bad debt has not declined. Kodiak attributed the contrast to the increasing use of “higher deductibles, greater coinsurance, and more complex cost-sharing structures: all elements that increase the nominal patient responsibility without improving—and often reducing—the probability of collection.”

The gains at the front end are “being absorbed by the growing difficulty of collecting what remains,” Kodiak stated in the analysis.

“Hospitals are left in the lurch with these trends,” Brian Sanderson, a principal in the healthcare consulting group at Crowe, said in a 2022 report. “Labor scarcity makes for fewer experienced personnel looking to navigate increasing complexities of insurance coverage, while patient out-of-pocket costs continue to rise dramatically.”

Notably, of the 17 percent of providers that officially require prepayment, 68 percent ultimately proceed with care even if the requirement is not met, according to PayZen.

Affordability Crisis

Thirty percent of Americans or their family members had problems paying for healthcare in the past 12 months, according to an April poll from KFF, formerly Kaiser Family Foundation, a healthcare policy nonprofit.

“Many U.S. adults may be one unexpected medical bill from falling into debt,” KFF stated. About half of U.S. adults said in April they would be unable to pay for an unexpected $500 medical bill in full without going into debt.

Healthcare costs ranked as the top financial worry for Americans. Lowering out-of-pocket costs became the most critical change needed in healthcare for half of insured adults, according to the poll.

From 2025 to 2026, the average deductible in the Affordable Care Act marketplace increased 37 percent—over $1,000 per person—from $2,759 to $3,786. This marks the steepest increase since the marketplace launched in 2014, according to KFF.

The average annual deductible for a single-coverage, employer-sponsored plan increased by 70 percent over a 12-year period, from $1,273 in 2013 to $2,169 in 2025. The average family deductible surged 60 percent to about $4,000 in 2025, according to KFF.

Healthcare costs led nearly 40 percent of Americans to put off needed care or prescribed medications in the 12-month period ending in April 2026, according to a KFF poll.

Medical Debt Reporting Bans

As of July 2025, 15 states have enforced the ban on including medical debt in credit reports: California, Colorado, Connecticut, Delaware, Illinois, Maine, Maryland, Minnesota, New Jersey, New York, Oregon, Rhode Island, Vermont, Virginia, and Washington, according to the National Consumer Law Center.

“Credit reporting, a threat traditionally used by medical providers and debt collectors to induce patients to pay their bills, is the most common collection tactic used by hospitals,” KFF said in a 2024 report.

As states ban medical debt reporting, hospitals lose a primary leverage tool for post-care debt collection. In response, providers push harder for upfront prepayments, according to think tanks.

Removing medical debt from credit reports reduces the incentive for consumers to pay their bills. It is triggering reactions from providers that affect healthcare access, according to the American Enterprise Institute.

“Providers are securing larger share of payment prior to delivering services in recent years and relying on medical credit cards to secure prompt payment. These kinds of trade-offs are important for policymakers to consider,” the think tank’s senior fellow Benedic N. Ippolito stated in a statement before the Senate Committee on Health, Education, Labor and Pensions in July 2024.