92% of Health Providers Want Patients to Prepay

Americans are being asked to pay for costly medical procedures up front.

Roughly 92% of U.S. health providers this year are either encouraging prepayment, requiring it, or collecting a payment method to have on file during the estimate process, The Wall Street Journal (WSJ) reported Sunday (Sept. 6).

That’s up from 81% in 2025, the report added, citing a survey conducted by patient payment service provider PayZen, and the Healthcare Financial Management Association.

According to the report, this trend is leading to sticker shock among patients, along with some paperwork nightmares. In some cases, patients will overpay and have to try to collect refunds, while others pay several thousand dollars, only to discover they owe thousands more.

This practice is the result of insurers shifting more costs to patients, which leaves hospitals stuck when bills go unpaid, Molly Smith, vice president at the American Hospital Association, told WSJ.

About half of patients’ shares of the bills remain unpaid one year after a healthcare service, the report added, citing a study published in 2025 in the JAMA Health Forum.

While hospitals can’t refuse emergency care based on payment status, that still leaves patients in situations where they put off things like ACL tear repairs or minimally invasive heart procedures, where postponing could present health risks, WSJ said.

“It’s kind of heartbreaking because if you don’t have the funds at that time, you have to put it off, and that could really have consequences,” said Phyllis Bass, who lives in Cypress, Texas, and volunteers for the Patient Advocate Foundation, a nonprofit patient assistance organization.

Bass said she has held off injections for rheumatoid arthritis and an MRI scan because she couldn’t afford to cover the estimate in advance.

Research by PYMNTS Intelligence has shown that choices like this are not uncommon. For example, The Wage to Wallet Index shows consumers use medical bills and subscriptions as the primary “safety valves,” allowing them to cover the cost of housing and car payments.

“Labor Economy workers delay medical bills at a rate of about 30.3%, while delinquency on housing and transportation remains comparatively low, generally in the 10% to 13% range,” PYMNTS wrote earlier this year. “In effect, households accept future credit or medical consequences to preserve present employability and housing stability.”

Meanwhile, additional PYMNTS Intelligence research finds that some consumers are turning to buy now, pay later (BNPL) plans to cover health-related expenses, with 55% of Gen Z consumers saying BNPL availability influences where they seek medical or dental care.