Hospitals Are Asking More Patients to Pay Upfront as Healthcare Costs Keep Climbing

Thomas Zordani flew from Denver to Phoenix for a consultation with a Mayo Clinic neurosurgeon, hoping to learn what could be done about debilitating headaches after a worrisome brain scan. He’d been told the clinic accepted his insurance. Instead, staff sent him straight to the financial office and demanded $5,000 before he could see the doctor. He didn’t have that kind of cash on hand. His appointment was canceled.

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Mayo Sent Him a $565 Estimate, Then Asked for $5,000 in Person

Zordani later learned Mayo had messaged his insurance portal days earlier with a cost estimate of $565, a fraction of the $5,000 he faced in person. The clinic had since determined it did not accept his plan and automatically classified him as self-pay, even though his coverage included out-of-network benefits. Staff never asked his permission before making that designation, and he still doesn’t know how the $5,000 figure was calculated.

Mayo Says the Visit “Did Not Meet” Its Own Communication Standard

Mayo’s communications director, Andrea Kalmanovitz, said in an emailed statement that the clinic regrets Zordani’s experience did not meet its usual standard for explaining insurance coverage and financial responsibility. Mayo’s website confirms it requires prepayment for noncontracted, or out-of-network, plans in a range of circumstances. The statement never mentioned what happened after Zordani went home to Denver, or the legal fight that followed.

Patients Are “Basically Being Asked to Self-Insure,” Finance Expert Says

Zordani’s experience reflects a shift spreading across American hospitals. Providers are collecting larger shares of what patients owe just as rising deductibles push more of the cost directly onto patients. Richard Gundling, a senior vice president at the Healthcare Financial Management Association, said patients are basically being asked to self-insure. As deductibles climb, hospitals expect more people to struggle paying them, so they’re moving to collect money before treatment instead of after.

A Former Hospital Industry CEO Predicts These Deposits Will Keep Growing

Chip Kahn, a visiting senior fellow at KFF and the American Enterprise Institute who once led the Federation of American Hospitals, expects the trend to accelerate. He said preservice deposits and similar moves are likely to become more common, adding pressure on both providers and patients. Diane Spicer, a supervising attorney with Community Health Advocates in New York, said her organization mostly hears from insured people seeking out-of-network care who assumed their coverage would apply.

Deductibles Have Climbed to Nearly $3,800 a Year

The numbers explain the squeeze. The average deductible in employer-sponsored family coverage is now $3,762 per person, according to KFF. Deductibles in Affordable Care Act marketplace plans jumped 37 percent this year, landing at a similar $3,786. A recent KFF tracking poll found lower out-of-pocket costs ranked as the top change insured adults wanted from their coverage. Hospitals are responding to that same financial pressure from the other side of the ledger.

Hospitals Now Collect a Quarter of What Patients Owe Before Treatment

Kodiak Solutions, which tracks hospital revenue data nationwide, says providers now collect about a quarter of what they expect a patient will owe before treatment even happens. Vice president Matt Szaflarski gave an example: if insurance will reimburse $1,000 for a scan, the hospital now asks for $250 up front, up from roughly $150 a few years ago. Collection rates vary by state too. Indiana ranks among the lowest, while California and Texas collect more.

Unpaid Bills Are Rising Even as Hospitals Collect More Up Front

That collection push hasn’t solved hospitals’ money problems. A joint investigation covering more than 2,300 hospitals found insured patients have almost no federal legal protection from these upfront demands, and that hospitals collected roughly a quarter of what patients owed before care in early 2026, up from about 22.7 percent a year earlier. Uncollected debt kept climbing anyway, which Kodiak attributed to a fundamental shift toward higher deductibles and more complex cost-sharing that reduces the odds hospitals get paid at all.

Out-of-Network Patients Have Almost No Legal Protection Against Deposits

Legal protection is limited. Hospitals that accept federal Medicare funding cannot demand payment before stabilizing an emergency room patient, said Matthew Fiedler of the Brookings Institution, but out-of-network deposits face no such barrier. Patricia Kelmar of PIRG said patients often can’t tell if a $1,500 demand reflects a fraction of their bill or their entire remaining deductible. Overpayment refunds are just as murky, and few states set clear rules for how fast hospitals must return the money.

Zordani Won $47,500 After Arizona Ruled Mayo Broke Consumer Fraud Law

Zordani filed a complaint against Mayo in Arizona civil court that fall. An arbitrator awarded him $47,500 in damages and attorney fees in September 2025, ruling Mayo violated the state’s consumer fraud law by failing to warn him his plan was out-of-network before he flew to Phoenix. Arizona also sued SimonMed Imaging over year-long refund delays, forcing the chain to repay patients within 60 days, an early sign regulators are starting to catch up with a billing practice hospitals built largely without oversight.