An ImagineSoftware employee recounts her experience with surprise billing, along with the tools that would have made paying her doctor easier and more convenient.


I’m walking out of my doctor’s office after my final round of vaccinations. I’m traveling to South America for vacation in a few weeks and couldn’t be more excited! I felt more prepared than ever to leave the country for the first time. What I wasn’t prepared for was what awaited me at the administration desk afterwards.

surprise billing and patient responsibility

The woman at the front desk greeted me with a warm smile and said, “Your total today is $450. How would you like to pay?” I thought my jaw was going to unhinge itself, I couldn’t drop it any farther. After a not-so-quick recovery, I asked, “I’m sorry, how is that possible? Can you check again? I thought my insurance covered my vaccinations.” I was sure of it, I had awesome health coverage. The noise her nails made as they rapidly clicked on her keyboard gave me instant anxiety. “Well, it looks like you haven’t paid for your initial consultation with the doctor yet, and not all of your vaccinations were covered, just a few.” I was reeling. I couldn’t recall anything in the mountain of paperwork I had filled out about a consultation cost or only some of my vaccinations being covered. I reluctantly handed over my debit card and left the doctor’s office with my arms AND my wallet hurting.

Surprise billing!

$450 may seem like a drop in the bucket to some, but not for me. As a 25-year-old woman with graduate student loans who recently opened up a Roth IRA because she’s trying to be financially responsible, those type of surprises are NOT okay. I couldn’t believe that cost wasn’t communicated to me upfront when I walked in for my first round of vaccinations. The money I had set aside for food and hotels during my trip now had to be spent on my doctor’s visit.

How to determine patient responsibility

The sooner, the better. As a patient, I want to know immediately how much my visit will cost. Explain your financial policies right away, including what payments are expected at time of service. Insurance verification should be completed upfront as well. It will reduce your time spent chasing down my insurance company or sending me multiple billing statements if I can’t pay upfront. All I really want as a patient is for you to be transparent. That means also training your office staff to make sure they can correctly answer questions about pricing over the phone and in person. Include a concise, written description of patient responsibility for making copayments at time of service and how you invoice coinsurance and deductibles.

Imagine a future where patients are equal partners in managing their healthcare costs.

I pay for everything online, why should my medical bills be different?

My rent, my clothes, my student loans… I could go on forever. Almost everything is paid online. Online bill pay – like PayPal and Venmo – is a beautiful thing. It’s convenient, secure, and I’m more likely to pay right away if it can be done from my phone or laptop. A few months ago, I received a mailed invoice from my doctor that I completely forgot about. It was three days from going to collections when I realized I needed to call and pay. Let’s be honest here, I have a lot going on from day to day, it was really easy to forget about a piece of paper that was mailed to me. When I finally called to make the payment, I was put on hold for twenty-minutes before an office member could speak with me and let me pay my bill. It’s not exactly what I’d consider an easy way to pay. Offering online bill pay has a ton of benefits for both you and your patients.

For you:

    • Receive payments faster and more frequently. 
    • Reduce the amount of time your staff follows up with late payers. 
    • Reduce the volume of payment-related calls to your office. 
    • Increase patient satisfaction - there's a much higher likelihood of me staying with your practice in the long-term and suggesting your services to my family and friends. Word-of-mouth happens to be one of the most influential ways for you to gain new patients!

For your patients:

    • We won't have to write and mail checks or abide by practice office hours to pay over the phone, it's instant!
    • We feel more in control - it feels good to pay a bill from anywhere on my own time.
    • We will feel much more connected to you. Giving us that option lets us know that you care about convenience and efficiency, and that speaks volumes.


It's a struggle for many patients to pay their medical bills immediately.

If I had been unemployed, there’s no way I would have been able to afford a $450 bill upfront. On the other hand, when you write off past-due balances as losses, you’re going to severely hurt your practice’s financial health in the long-run. You should try to collect on every dollar you’re entitled to, and a great alternative is offering a patient payment plan. Giving us the ability to flexibly pay over time can make a huge difference in helping us fulfill our financial responsibilities, and make your practice more money. There are a ton of benefits to these plans as well:

    • Since we're opting into the plan instead of being forced to pay the entire bill upfront, we're much more likely to pay for it.
    • According to the Medical Management Association (MGMA), practices that have implemented payment plans reported higher levels of patient satisfaction! 
    • There's much more opportunity for you to progress financially. Even if some of your patients' payments aren't coming through at the time of service, a payment plan will slowly but surely bring them in instead of you writing them off as bad debt. 

When you work proactively to provide your patients the best billing experience, you’ll gain loyal patients and experience better collection results. It’s a clear win!



As a long-time writer and content marketer, Jenna Tropea covers a wide range of topics from patient engagement to healthcare policy and regulations. Jenna received her MBA from Clemson University and currently serves as Online Marketing Strategist to ImagineSoftware.