You schedule a procedure, scan, or specialist visit. Before you receive care, the billing office tells you that you need to pay part of the anticipated cost upfront. It may be a few hundred dollars or several thousand.
Later, after the claim is processed, you learn that your actual responsibility was lower than the amount you prepaid. Maybe your insurance covered more than expected. Maybe the procedure changed or was canceled. Maybe another provider’s bill was applied to your deductible first.
Either way, you appear to have paid more than you ultimately owed.
So what happens to the difference?
Baron, Herskowitz & Cohen is reviewing how hospitals and other medical providers are handling patient prepayments, overpayments, and refunds. We are interested in speaking with Florida patients who paid more upfront than they ultimately owed and did not receive the difference back.
These conversations will help us better understand how providers are handling these accounts, what patients are being told, what correspondence they are receiving, and whether particular practices may give rise to legal claims. Contact us.
Why Are Medical Providers Collecting Money Before Treatment?
Traditionally, many patients received a bill for their portion of medical care after treatment. Increasingly, hospitals and other providers are asking patients to pay some or all of their estimated responsibility before services are provided.
KFF Health News recently reported that hospitals are collecting larger portions of what they expect patients to owe before treatment. According to a revenue-cycle executive at Kodiak Solutions cited in the report, hospitals now collect about one-quarter of their expected patient responsibility upfront, compared with roughly 15% in the past. One reason is the growing amount patients are responsible for paying themselves. KFF Health News also reported that average deductibles have continued to rise, making providers more concerned about collecting patient balances after care has already been provided.
For patients, however, there is an obvious complication: the amount collected before treatment may not ultimately match what the patient actually owes after services are provided and insurance claims are processed.
What Is a Medical Prepayment?
A medical prepayment is money collected before a patient receives care. Depending on the provider, it may be called a:
- Pre-service deposit
- Advance deposit
- Estimated patient responsibility
- Point-of-service payment
- Pre-admission payment
The amount may be based on the patient’s deductible, coinsurance, estimated procedure cost, or another calculation used by the provider.
But the initial number is still an estimate. Insurance payments, changes in treatment, other medical bills and adjustments can all affect the patient’s final responsibility.
When the final amount is lower than the amount prepaid, an overpayment may result.
How Can an Overpayment Happen?
There are several ways a patient may end up paying more than ultimately required.
For example:
- Insurance paid more than expected. The provider estimated that the patient would owe a certain amount, but the claim was ultimately processed differently.
- The procedure or treatment changed. Services included in the original estimate may not have been performed.
- The procedure was canceled. A patient may have paid a deposit for care that never occurred.
- Other medical bills affected the deductible. An anesthesiologist, surgeon, laboratory or other provider may have submitted a claim first, changing how much remained on the patient’s deductible.
- A payment was made twice. A patient may have prepaid an amount and later paid another statement without realizing the earlier payment should have been credited.
- A payment was not properly credited. The provider may have received the money but failed to apply it correctly to the patient’s account.
A Recent Example Shows How Complicated Prepayments Can Become
KFF Health News reported on the experience of a Denver patient who traveled to Phoenix for an appointment with a neurosurgeon.
Before the visit, he received an estimate showing a cost of $565. When he arrived, however, he was told that the clinic no longer accepted his insurance and that he would need to make a $5,000 pre-service payment.
He declined, and the appointment was canceled.
The patient later pursued a complaint in Arizona. According to the reporting, an arbitrator determined in September 2025 that the clinic had violated Arizona’s consumer fraud law by failing to notify him in time that his plan was no longer considered in-network. He was awarded $47,500 in economic damages and attorney fees.
The circumstances of every patient’s bill are different, but the case illustrates why the information given to patients before care, how prepayments are calculated, and what happens to that money afterward can matter.
What Does Florida Law Say About Patient Overpayments?
Florida law contains provisions requiring certain health care providers and facilities to refund patient overpayments within 30 days after determining that an overpayment was made.
Whether those requirements apply in a particular situation can depend on the type of provider, how the payment was collected and billed, and the circumstances surrounding the overpayment.
That is why it is important to look at the patient’s actual bills, explanation-of-benefits statements, receipts, account history and correspondence with the provider rather than assuming that every delayed refund presents the same legal issue.
How Long Are Patients Waiting for Refunds?
Florida is not the only place where regulators and patients have raised concerns about medical overpayments.
Other states have also addressed certain prepayment practices, including restrictions designed to prevent hospitals from using prepayments to avoid financial-assistance obligations.
These developments are part of a broader discussion about what happens when providers collect estimated medical costs before anyone knows exactly what the patient’s final responsibility will be.
What About Payment Before Emergency Care?
Emergency care is different from scheduled medical care.
Under the federal Emergency Medical Treatment and Labor Act, or EMTALA, most hospital emergency departments must provide an appropriate medical screening examination and, when an emergency medical condition exists, stabilizing treatment regardless of a patient’s ability to pay.
Hospitals may ask about insurance or payment, but those inquiries should not delay the screening or stabilizing treatment required by federal law.
Signs You May Have Overpaid
It may be worth taking a closer look at your account if you:
- Paid an estimated amount before receiving care and later learned your actual responsibility was lower.
- Received a statement showing a credit balance but have not received a refund.
- Were told a refund was being processed but weeks or months have passed.
- Paid upfront for a procedure that was later canceled or changed.
- Paid the provider and later learned that your insurance company also paid more than expected.
- Cannot get a clear explanation from the billing department about whether you have a credit.
- Received correspondence requiring you to take additional steps before money already credited to your account will be returned.
Even if you are unsure whether you overpaid, your records may help clarify what happened.
What Should You Do If You Think You Are Owed a Refund?
Start by gathering the documents that show what you paid and what you ultimately owed.
That may include:
- Your itemized bill. Request a detailed statement showing the services and charges.
- Your insurance Explanation of Benefits. Compare what the provider billed, what insurance paid and what the plan says you were responsible for.
- Proof of your payments. Save receipts, credit card statements, canceled checks and online payment confirmations.
- Any estimates you received before treatment.
- Statements showing a credit balance.
- Emails, letters and patient-portal messages concerning the refund.
- Notes from conversations with the provider’s billing department.
If the numbers do not add up, ask the provider for a written explanation of the account and the status of any refund.
Other Medical Billing Issues We Are Reviewing
Unreturned prepayments are not the only medical billing issue Baron, Herskowitz & Cohen is interested in reviewing.
The firm is also interested in hearing from patients who have experienced issues such as:
Unexpected out-of-network bills. You received care at an in-network hospital or facility but were later billed by a provider you did not realize was out of network.
Bills substantially exceeding an estimate. You received an estimate before treatment but the final bill was significantly higher without a clear explanation.
Charges for services you did not receive. Your bill includes procedures, tests, supplies or other services that you believe were never provided.
Collection activity involving amounts you believe were already paid. You paid the amount you understood you owed but later received collection notices or demands for additional payment.
Questions involving upfront payments for emergency care. You were asked for payment in connection with emergency treatment and have questions about whether the billing process affected your care.
Whether any particular billing issue creates a legal claim depends on the facts. The firm is gathering information from patients to better understand the billing practices being used and determine whether legal options may be available.
Frequently Asked Questions
Does Florida law require medical overpayments to be refunded?
Florida law contains provisions requiring certain health care providers and facilities to refund patient overpayments within 30 days after determining that an overpayment was made. Whether those provisions apply to a particular situation can depend on the provider and circumstances.
Can a hospital require payment before a scheduled procedure?
In many situations, a provider may request payment before non-emergency care. Because the amount is often based on an estimate, however, the patient’s final responsibility may be different once the services are provided and insurance claims are processed.
What if my procedure was canceled after I prepaid?
Ask the provider for an updated account statement showing how your payment was applied and whether the account has a credit balance. Keep copies of your payment records and any correspondence concerning a refund.
What if I do not know whether I overpaid?
Request an itemized bill and compare it with your insurance Explanation of Benefits and your payment records. If you cannot determine how the provider arrived at the final balance, request an explanation from the billing department.
What if the provider keeps telling me my refund is being processed?
Document each communication, including the date, who you spoke with and what you were told. Keep any emails, letters or portal messages concerning the refund.
Contact Baron, Herskowitz & Cohen
If you believe you made a medical prepayment that should have been refunded, or you are dealing with another medical billing problem, contact Baron, Herskowitz & Cohen.
Share your experience through the form below. If possible, have copies of your bills, payment records, insurance statements, estimates and correspondence from the provider available. Those documents can help us better understand what happened and determine whether there may be legal options to consider.
