The trend: More hospitals and medical groups are pushing their patients to pay for care upfront, according to a recent story in The Wall Street Journal. PayZen data cited in the story show that 92% of US providers in 2026 encourage or mandate prepayment, or collect a payment method during the estimate process, up from 81% last year.

Driving the trend: Patients are paying more out of pocket as more are steered into high-deductible health plans, while insurers tighten coverage or outright deny paying for select expensive drugs and procedures.

When deductibles haven’t been met, or coverage is lacking, patients can face large bills instead of familiar copays. Some 31% of US adults said they cannot afford to pay an unexpected $500 out-of-pocket medical bill, per a December 2025 Nationwide Retirement Institute survey. This could lead to delaying or missing post-service payments, prompting providers to change how and when they collect.

Why it matters: Consumers already struggle to afford care—requiring prepayment can intensify the burden by forcing patients to cover large expenses immediately. In an April KFF poll, 30% said they were “very worried” about affording healthcare, more than any other expense.

Plus, paying the quoted price upfront doesn’t guarantee that costs end there. One patient interviewed by the WSJ paid $3,500 in advance for hernia-repair surgery, only to be billed thousands more for add-on services in the following months. His experience is far from unique: unexpected medical bills weeks or months after paying for initial care are common.

Prepayment policies vary among hospitals and doctors’ offices, and some carry extreme consequences for patients. Some organizations require prepayment, while others offer discounts for paying in advance or collect a portion upfront before moving patients to longer-term payment plans. Some providers may refuse nonemergency care when patients do not pay upfront. Among the 17% of patient care organizations that officially mandate prepayment, 68% do proceed with care even if payment is not made—meaning many likely deny care—according to PayZen data cited by the WSJ.

Implications for healthcare providers: Health systems and insurers will blame each other as more costs shift to patients. What ultimately matters, however, is the effect of forcing people to pay upfront, which may lead them to delay or forgo scheduled procedures and surgeries.

Providers cannot wait indefinitely for payment, but fair business practices should include clear, accurate upfront estimates without surprise add-on charges, as well as financial assistance and counselors who help patients understand their options. These measures can strengthen trust between providers and patients and reduce the need for health systems and collection agencies to pursue unpaid medical debt.