Many hospitals and other health-care providers and facilities now ask lots of patients to prepay for procedures. It isn’t just patients lacking health insurance who are being asked to ante up in ­advance—insured patients frequently are asked to prepay potential out-of-pocket costs, including co-pays, co-insurance and deductibles. These kinds of bills can easily add up to hundreds or thousands of dollars.

Problem: Billing on estimate—before the patient’s insurance company processes the claim and reimburses the facility—opens the door to overbilling. And paying in advance could undercut patients’ ability to negotiate a lower charge. Once a provider has a patient’s money, it has less incentive to offer discounts or provide financial assistance.

What to do: If you’re asked to pay in advance and you have health insurance or Medicare, politely decline, saying, “I’ll wait until I receive my Explanation of Benefits statement from my insurance company (or Medicare) so that I can see how much I actually owe.”

If the provider refuses to provide treatment, pay the bill with a credit card. Contact the credit card issuer soon after the procedure and ask to dispute the payment because it’s not clear how much you owe until after your insurer pays its share. The Fair Credit Billing Act gives consumers the right to dispute credit card charges that list the wrong amount, so card issuers often agree to put payments on hold under these circumstances. 

Alternatively, if you likely will have to pay much or all of the cost of a procedure out of pocket because you don’t have insurance…haven’t yet met your deductible…and/or the procedure or provider is not well-covered by insurance, you could ask the provider to give you a discount in exchange for prepaying. Savings of as much as 25% sometimes are possible. 

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