2026年8月12日 美国东部时间早上5:00 / KFF健康新闻
托马斯·佐尔达尼从丹佛的家中飞往凤凰城，与梅奥诊所的一名神经外科医生面诊，希望在脑部扫描结果异常后，能找到治疗其顽固性头痛的方案。
佐尔达尼表示，预约时他被告知该诊所属于其保险的签约网络内机构。但抵达后，他被带到诊所财务办公室，被告知需预付5000美元的服务前押金，因为梅奥诊所后来确认不接受他的保险。尽管他的保险计划包含非网络内医疗保障，他还是被自动列为“自费患者”。
由于手头没有这笔现金，且原则上对此感到愤怒，他拒绝了付款，预约也被取消。
“我当时怒不可遏，”佐尔达尼回忆起2024年4月初的那天说道。后来他得知，在面诊前不久，梅奥诊所曾通过其保险公司的患者门户向他发送过费用预估：565美元，而非后来索要的高额款项。
传统上，患者通常在接受治疗后才会收到需自付部分的账单。但佐尔达尼遭遇的情况正变得越来越普遍——医院或其他医疗服务机构开始要求提前付款。
“我们对这位患者的体验未达到我们在帮助患者了解保险覆盖范围和经济责任时所力求达到的高标准沟通服务表示遗憾，”梅奥诊所传播总监安德里亚·卡尔马诺维茨在一封电子邮件声明中说道。“当潜在患者不清楚梅奥诊所不在其健康保险计划的签约网络内时，可能会出现意外的服务前押金要求。”
梅奥诊所的网站显示，其在多种情况下要求预付款，包括针对“非签约”——也就是非网络内——的保险计划。
医院要求提前付款的趋势对患者而言是双重打击。
医疗服务机构在患者可能需要自付份额越来越高的时候收取费用：不断上涨的自付额意味着患者需要为医疗服务支付更多费用。例如，服务前押金可能是剩余自付额的全部或部分，或是就诊或治疗费用的相当大比例。随着医院价格、药品成本和劳动力成本上涨，保险公司试图通过将更多成本转移给患者来减缓保费增长，这导致自付额进一步上升。
“人们基本上被要求自我保险，”美国医疗财务管理协会的高级副总裁理查德·冈德林说道。该协会是为医疗金融专业人士设立的组织。
随着这种情况的发展，医院估计会有更多患者难以承担这些自付额，因此他们希望尽可能多地提前收款。
“服务前押金这类举措可能会越来越常见，”KFF及美国企业研究所访问高级研究员、美国医院联合会前总裁兼首席执行官奇普·卡恩说道。“这对医疗服务提供者、临床医生和患者都会造成更大压力。”
这些押金不能孤立看待，冈德林表示：这不仅仅是医院提前收钱这么简单的问题。他说，真正的挑战在于：“当越来越多的患者无法承担当前的自费成本时，我们该如何维持医疗服务的可及性？”
消费者已经越来越担心医疗费用的支付问题。KFF最近的一项健康跟踪民调显示，降低自费成本是参保成年人最希望从其保险计划中看到的改进措施。KFF是一家健康信息非营利组织，旗下包括KFF健康新闻。
根据KFF的数据，雇主提供的家庭保险计划中，人均自付额平均为3762美元，而《平价医疗法案》计划的平均自付额今年上涨了37%，达到相近的3786美元。
消费者的担忧
纽约州健康保险消费者援助项目“社区健康倡导者”的主管律师黛安·斯派塞表示，该机构经常接到担心预付费用的民众咨询。
“我们接触的大多是寻求非网络内医疗服务但拥有非网络内保障的参保人群，”斯派塞说道，“有时也会针对不在保险覆盖范围内的医疗服务。”
为医疗系统提供收入管理服务的科技公司科迪亚克解决方案表示，目前尚不清楚有多少医院会收取这类常被称为“就诊点付款”的费用。
“但这正越来越多地成为我们与医疗系统沟通的核心议题，”领导科迪亚克收入循环情报团队的副总裁马特·扎弗拉斯基说道。
除梅奥诊所外，总部位于巴尔的摩的约翰·霍普金斯医学中心网站显示，其政策是“在服务提供前收取所有应付款项”，针对非急诊护理。休斯顿的德克萨斯大学MD安德森癌症中心是美国顶尖的癌症治疗机构之一，其表示自费患者“将根据癌症类型，被要求支付由治疗中心确定的初始押金”。
扎弗拉斯基表示，根据医院对保险公司支付金额的预估，医院平均会收取患者预计应付款项的四分之一，这一比例近年来有所上升。
例如，如果患者进行影像学检查，保险公司将为该扫描项目报销1000美元，医院会提前向患者收取250美元，他说道。“过去这一比例接近150美元。”
收费金额还因医院而异，有时甚至因州而异。
“印第安纳州的现金收取额是全国最低的之一，这里的人 Midwest nice（注：指中西部地区居民待人友善），”扎弗拉斯基说道。他补充道，加利福尼亚州和德克萨斯州是收取金额较高的地区之一。
然而，尽管医院越来越多地提前收取更多费用，其未收回的债务也在增加，根据科迪亚克从全国2300多家医院收集的数据。
科迪亚克6月的一份报告称，这是因为保险覆盖范围发生了“根本性转变”，保险计划“越来越多地设置更高的自付额、更高的共付比例和更复杂的成本分担结构：所有这些因素都增加了患者名义上的经济责任，但并未提高——往往反而降低了收款的可能性”。
尽管许多医院运营状况良好，但部分医院，尤其是农村地区的医院，利润率微薄——随着《平价医疗法案》和医疗补助计划的资金削减导致更多人失去保险，情况可能很快会进一步收紧。
因此，医院“必须关注每一笔成本分担款项”，卡恩说道。
佐尔达尼返回丹佛后，他花了一段时间才找到另一位专科医生。2024年6月下旬，他最终在丹佛一家与梅奥诊所无关的医院接受了治疗，修复了脑脊液漏。
同年秋天，他在亚利桑那州民事法院对梅奥诊所提起诉讼。2025年9月，一名仲裁员认定梅奥诊所违反了州消费者欺诈法，因为它在佐尔达尼出行前未通知他其保险计划不在签约网络内，最终裁定梅奥诊所赔偿佐尔达尼47500美元的经济损失和律师费。梅奥诊所给KFF健康新闻的声明中未提及该和解协议。
“如果他们按要求及时通知我，我根本不会飞往那里，”佐尔达尼说道。他仍然对诊所未经他同意就将其医疗服务列为自费感到愤怒，这意味着他无法使用保险报销，他也仍不清楚医院是如何计算出5000美元的服务前费用的。
消费者何时需要预付服务费用？
有一条明确的规则：布鲁金斯学会高级研究员、健康政策研究员马修·菲德勒表示，在紧急情况下，接受联邦医疗保险资助的医院依法不得在稳定急诊患者前要求提前付款。
其他消费者保护措施则不那么明确。
专家告诉KFF健康新闻，接受网络内医疗服务的患者可能在与保险公司的合同中拥有一些追索权，因此他们应该仔细阅读细则。
“在非网络内医疗场景中，我不清楚有任何障碍会阻止医疗服务提供者收取服务前押金，”菲德勒在谈到预付押金时说道。
这些费用的计算方式似乎也完全由医疗服务机构决定，且可能不透明。
“他们可以直接说1500美元，你可能会想，‘哦，这是10%的费用，还是我剩余的自付额？’”美国独立消费者权益倡导团体联合会PIRG的医疗活动高级主任帕特里夏·凯尔默说道。
不过她补充道，患者可能提前三个月预约，因此医疗服务机构可能不知道患者剩余的自付额是多少。她建议消费者索要明细账单，并致电保险公司了解其是否对收费有相关规定。
同样不明确的是，如果患者多付了费用，他们将如何以及何时获得退款。
如果患者不需要最初预估的服务，或者保险公司先支付了其他费用，例如麻醉费或外科医生的费用，就可能出现多付款项的情况。如果这些付款被计入患者的自付额，而患者已经提前向医院预付了预计的自付额，那么他们就向医院多付了钱。
患者获得退款的时间可能各不相同，且可能取决于州法律，尽管少数州直接对此问题做出了规定。截至今年，佛罗里达州要求医疗服务机构在确认多付款项后的30天内向患者退款。包括马里兰州在内的一些州禁止某些医院仅为避免提供经济援助而要求预付费用。
在指控部分患者等待退款超过一年后，亚利桑那州总检察长克里斯·梅斯近期根据州消费者保护法对西蒙德影像公司提起诉讼，该公司在10个州拥有170家门店。
在和解协议中，西蒙德影像公司同意平均在60天内完成退款。
_KFF健康新闻_是一家全国性新闻编辑部，专注于制作健康议题的深度报道，是KFF的核心运营项目之一——KFF是独立的健康政策研究、民调与新闻资讯来源。
Hospitals push for upfront payments as patient deductibles and out-of-pocket costs rise
August 12, 2026 5:00 AM EDT / KFF Health News
Thomas Zordani flew from his home in Denver to Phoenix for a consultation with a Mayo Clinic neurosurgeon, hoping to find out what could be done to treat his debilitating headaches after worrisome brain scan findings.
When making the appointment, Zordani said, he’d been told the clinic was in his insurer’s network. Upon arrival, Zordani was summoned to the clinic’s financial office and told he had to make a $5,000 preservice deposit, because Mayo had since determined it did not accept his insurance. He was automatically designated “self-pay,” even though his plan had out-of-network benefits.
Not having that kind of cash on hand — and angry on principle — he refused. His appointment was canceled.
“I was so livid,” Zordani said, recalling that day in early April 2024. He later learned that Mayo had sent a message to him in his insurance carrier’s patient portal shortly before his visit with an estimate of the cost: $565, not the larger amount it later demanded.
Traditionally, patients usually receive bills for their share only after getting treatment. But what Zordani faced is becoming increasingly common — hospitals or other medical providers seeking prepayments.
“We regret that this individual’s experience did not meet the high standard of communication we strive to provide when helping our patients understand their insurance coverage and financial responsibility,” Andrea Kalmanovitz, Mayo’s communications director, said in an emailed statement. “When prospective patients don’t have clarity that Mayo Clinic is not in-network with their health plan, unexpected pre-service deposit requests may result.”
Mayo’s website says it requires prepayments in a variety of cases, including for “noncontracted” — also known as out-of-network — insurance plans.
The trend of hospitals asking for money up front represents a double whammy for patients.
Medical providers are collecting larger shares of what patients might owe at a time when rising deductibles mean patients are owing more for care. The preservice charge could be all or part of a remaining deductible, for example, or a sizable percentage of what the visit or treatment might cost. Those deductibles go up when hospital prices, drug costs, and labor expenses increase, as insurers try to slow premium growth by shifting more costs to patients.
People are “basically being asked to self-insure,” said Richard Gundling, a senior vice president at the Healthcare Financial Management Association, an organization for finance professionals.
As that happens, hospitals figure more patients will have trouble meeting those deductibles, so they want to get as much up front as possible.
“Things like preservice deposits and those kinds of moves are probably going to become more and more likely,” said Chip Kahn, a visiting senior fellow at KFF and the American Enterprise Institute and former president and CEO of the Federation of American Hospitals. “That will make it harder on the provider, the clinician, and harder on the patients.”
The deposits can’t be viewed in isolation, Gundling said: It’s a bigger issue than just hospitals asking for money up front. The challenge, he said, is: “How do we maintain access to care when more patients can’t absorb the level of out-of-pocket costs?”
Already, consumers are increasingly worried about paying for healthcare. A recent KFF health tracking poll found that lower out-of-pocket costs ranked as the top change insured adults would like to see from their coverage plans. KFF is a health information nonprofit that includes KFF Health News.
The average deductible in family coverage offered by employers is $3,762 per person, according to KFF, while the average deductible in Affordable Care Act plans jumped 37% this year to a similar amount, $3,786.
A consumer concern
Community Health Advocates, a health insurance consumer assistance program in New York state, hears from people who are concerned about prepayments, said Diane Spicer, a supervising attorney.
“We see this mostly with insured folks who are seeking out-of-network care but who have out-of-network coverage,” Spicer said, “and also sometimes for care that is not covered.”
Just how many hospitals collect what are often called point-of-service payments is not known, according to Kodiak Solutions, a technology company that provides services to health systems to help manage their revenue.
“But it is becoming more and more the center of many of our conversations with health systems,” said Matt Szaflarski, a vice president leading Kodiak’s revenue cycle intelligence team.
In addition to Mayo, Baltimore-based Johns Hopkins Medicine’s website says that “it is our policy to collect all amounts owed before services are rendered” for non-emergency care. University of Texas-affiliated MD Anderson in Houston, one of the nation’s premier cancer treatment centers, says patients who pay for their own care “will be asked to pay an initial deposit determined by the care center, based on the type of cancer.”
On average, hospitals collect about a quarter of what they expect the patient will owe, Szaflarski said, based on what they estimate the insurer will pay — a percentage that has grown in recent years.
For example, if a person is coming in for imaging and the insurer will reimburse $1,000 for that scan, the hospital will seek $250 from the patient up front, he said. “That used to be closer to $150.”
It also varies by hospital, and sometimes by state.
“The state of Indiana has some of the lowest cash collections in the country. They are Midwest nice,” Szaflarski said. He added that California and Texas are among those that collect more.
Even as hospitals increasingly collect more upfront payments, however, their uncollected debt is also rising, according to data Kodiak collected from more than 2,300 hospitals nationwide.
A Kodiak report in June said that’s because of a “fundamental shift” in coverage as plans “increasingly feature 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.”
While many hospitals are doing fine, some, especially in rural areas, have thin margins — and things could soon tighten further as cuts to ACA and Medicaid funding lead to more people being uninsured.
As a result, hospitals “have to be concerned” about every cost-sharing dollar, Kahn said.
After Zordani returned to Denver, he said, it took a while to find another specialist. He eventually had a procedure in late June 2024, at a Denver hospital not affiliated with Mayo, to fix a spinal fluid leak.
The following fall, he filed a complaint against Mayo in Arizona civil court. He was awarded $47,500 in economic damages and attorney fees after an arbitrator in September 2025 determined Mayo violated a state consumer fraud law because it failed to reach him to say that his plan was not in-network before he traveled. Mayo’s statement to KFF Health News did not include any reference to the settlement.
“Had they notified me in timely fashion as required, I would not have flown there,” Zordani said. He’s still angry that the clinic didn’t ask his permission before designating his care as self-pay, which meant he wasn’t going to use his insurance, and he’s still unclear on how they calculated the $5,000 preservice amount.
When do consumers have to make preservice payments?
There is one clear rule: In emergency situations, hospitals that accept federal Medicare financing cannot, by law, demand upfront payment before stabilizing a patient who arrives at an ER, said Matthew Fiedler, a senior fellow and health policy researcher at the Brookings Institution.
Other consumer protections are less clear.
Patients who get in-network care may have some recourse in their contracts with their insurers, so they should check the fine print, experts told KFF Health News.
“In out-of-network settings, I’m not aware of any barriers that would prevent a provider from doing this,” Fiedler said of preservice deposits.
How those amounts are calculated also appears widely up to the provider and can be opaque.
“They could just say $1,500 and you’d be like, ‘Oh, is that 10%, or is that how much is left on my deductible?’” said Patricia Kelmer, senior director of healthcare campaigns at PIRG, a national federation of independent consumer advocacy groups.
Yet, she added, the patient might be scheduling three months in advance, so the provider wouldn’t know how much was left on the deductible. She recommends consumers ask for an itemized bill and call their insurer to find out whether it has rules regarding the charges.
Also unclear are how and when patients get their money back if they overpay.
Overpayments can happen if patients don’t require the services originally estimated or when insurers pay other bills first, such as the anesthesiology cost or a surgeon’s fees. If those payments are counted toward a patient’s deductible, yet the patient had already made a prepayment to the hospital for the expected deductible, they’ve now paid too much to the hospital.
How soon they get their money back can vary and can depend on state laws, though a small number of states directly address the issue. As of this year, Florida requires medical providers to reimburse patients within 30 days of a determination of an overpayment. Some states, including Maryland, prohibit certain hospitals from requiring prepayment simply to avoid offering financial assistance.
After alleging that some patients had to wait more than a year to get reimbursed, Arizona Attorney General Kris Mayes recently brought a suit under state consumer protection laws against SimonMed Imaging, which has 170 locations in 10 states.
In a settlement, SimonMed agreed to issue refunds within an average of 60 days.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at_KFF_ — the independent source for health policy research, polling, and journalism.