“Deductible Season” Dilemma: Do Patients Really Have to Pay These Overdue Bills?

A recent Reddit thread on r/HealthInsurance opens with a direct question: “There are no more credit reports on medical debts of any amount since January 2025. Why should I pay medical bills anymore?”

Several others echo this sentiment, wondering why they should pay after the bills have been collected.

Patients delaying or avoiding paying their medical bills is nothing new, but the impact is becoming increasingly difficult for providers to absorb as patient balances represent a larger share of revenue – and incentives to pay weaken.

While credit reporting agencies no longer track most medical debt, sites like Reddit are full of advice on how to avoid collections. These conversations are now expressed by generative AI tools like ChatGPT and Claude, which recycle the same advice to users seeking answers.

Healthcare consumers are not necessarily wrong to ask these questions. The rules for credit assessment have evolved throughout the year. While a federal court in July blocked a rule barring medical debt from appearing on credit reports, medical debt under $500 is no longer reported to credit reporting agencies. But just because some medical debts don’t show up on credit reports doesn’t mean patients no longer owe them. This simply means that provider practices must change the billing experience.

This need collides with the most financially challenging time of year in health care: deductible season, when deductibles are reset and patients pay the most out of pocket.

Every January, millions of Americans start over with their insurance deductibles, suddenly finding themselves responsible for hundreds or even thousands of dollars out of pocket. These amounts are increasing and continuing to increase as high-deductible health plans become more common. According to the Bureau of Labor Statistics, 51% of Americans with private insurance were enrolled in it in 2023. For billing teams, that means a wave of patient questions, payment plans and past due balances. Data from Inbox Health shows that healthcare organizations billed the highest total amount in February and collected the highest total in March, illustrating how turbulent the first few months of the year can be.

This year’s franchise season promises to be particularly difficult.

Changes to credit reporting rules have removed one of providers’ most effective deterrents to non-payment. That alone would be enough to create turbulence, but it’s compounded by additional regulatory changes that have left many patients uncertain about what their insurance actually covers. During the pandemic, telehealth visits were almost universally reimbursed. Now many are not. A patient who logs in for a video visit may not realize their plan no longer covers that service until the bill arrives. Meanwhile, the millions of people who lost their Medicaid coverage during the redetermination period are still discovering that their safety net is gone.

All of this creates a fog of misunderstanding that manifests itself in billing offices in the form of phone calls, frustration and unpaid balances. Before paying, patients want to know: Did my insurance really cover anything? Was this coded correctly? Am I being billed twice? When they can’t get quick answers, they often don’t pay at all.

How service provider practices can make up for lost ground

Providers must now compete on the strength of their communication: how clearly they explain prices, how quickly they respond, and how effectively they build trust in every interaction.

It’s easier said than done. Many practices are already understaffed and overburdened. The average billing representative spends much of January returning voicemails, explaining deductibles and processing payment plans. Even the most diligent teams cannot respond to every patient in real time.

Conversational AI has “entered the chat” to fill this gap. AI-powered billing platforms can now instantly and accurately answer patients’ most common questions: Why is my balance higher than normal? Can I divide this amount into smaller payments? Patients receive clear, simple explanations whenever they need them, not just during office hours.

When patients understand their bills, they are much more likely to pay them. The goal is not to pursue what is owed more aggressively, but rather more effectively by meeting patients where they are and making it clear to them which communication channels they are actually using.

The data already suggests where the future is headed. Patient liability now accounts for about a fifth of practice revenues, and collection rates are declining year over year. The methods of yesteryear – paper statements, call centers, third-party collectors – belong to an era when insurance covered the majority of a provider’s income.

In today’s complex and ever-changing billing landscape, transparency and convenience aren’t just niceties. For most providers, this is a prerequisite for financial viability. In a time when people are questioning not only their bills but also the institutions that send them, trust is the currency that matters most. This confidence comes from experience. When patients can get clear, quick answers about what they owe and understand their bill in context, it builds trust that their doctor has their best interests at heart. The better the payment experience, the more patients will believe in the fairness of what they are paying for.

This is reflected in patients’ online behavior; they’re not so much trying to game the system as figuring out how to navigate it. They ask legitimate questions to Reddit and ChatGPT because they are the only sources offering quick, plain-language answers. Providers who respond with clarity, empathy, and timeliness will not only be paid more reliably, but will also preserve something even more valuable: the fragile trust that underpins every part of the care experience.

Patients deserve the comfort of knowing they are being treated fairly. This assurance and the trust it establishes will remain the most effective collection tool for providers.

Photo: KLH49, Getty Images

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