A recent Reddit thread on r/HealthInsurance opens with a blunt question: “There’s no more credit reporting on medical debt of any amount since January 2025. Why should I pay any medical bills anymore?”
Several others echo the sentiment, questioning why they should pay at all once bills hit collections.
Patients delaying or avoiding medical bills isn’t new, but the impact is becoming harder for providers to absorb as patient balances make up a larger share of revenue – and incentives to pay grow weaker.
With credit-reporting agencies no longer tracking most medical debt, sites like Reddit are brimming with advice on how to dodge collections. Those conversations are now being vocalized by generative AI tools like ChatGPT and Claude, which recycle the same advice back to users seeking answers.
Healthcare consumers aren’t necessarily wrong to ask these questions. Credit-reporting rules have been in flux all year. While a federal court blocked a rule disallowing medical debt from appearing on credit reports in July, medical debt under $500 is no longer reported to credit bureaus. But just because some medical debt isn’t appearing on credit reports doesn’t mean patients no longer owe. It just means provider practices need to change the billing experience.
That need is on a collision course with the most financially fraught time of year in healthcare: deductible season, when deductibles reset and patients pay the most out of pocket.
Every January, millions of Americans start fresh on their insurance deductibles, suddenly responsible for hundreds or thousands of dollars out of pocket. Those amounts are growing, and continue to rise as high-deductible health plans become more common. According to the Bureau of Labor Statistics, 51% of Americans with private insurance were enrolled in one as of 2023. For billing teams, that means a surge of patient questions, payment plans, and overdue balances. Inbox Health data shows that healthcare organizations billed the highest total dollar amount in February and collected the highest total in March, illustrating just how turbulent the early months of the year can be.
This year’s deductible season looks to be uniquely challenging.
The credit-reporting rule changes have removed one of providers’ most effective deterrents against nonpayment. That alone would be enough to create turbulence, but it’s compounded by additional regulatory shifts that have left many patients uncertain about what their insurance actually covers. During the pandemic, telehealth visits were almost universally reimbursed. Now, many aren’t. A patient who logs on for a video visit may not realize that their plan no longer covers that service until the bill arrives. Meanwhile, millions who lost Medicaid coverage during the redetermination period are still discovering that their safety net has vanished.
All of this creates a fog of misunderstanding that shows up in billing offices as phone calls, frustration, and unpaid balances. Before paying, patients want to know: Did my insurance actually cover anything? Was this coded correctly? Am I being double-billed? When they can’t get quick answers, they often don’t pay at all.
How provider practices can make up lost ground
Providers now have to compete on the strength of their communication: how clearly they explain charges, how quickly they respond, and how effectively they build trust in every interaction.
That’s easier said than done. Many practices are already understaffed and stretched thin. The average billing representative spends much of January returning voicemails, explaining deductibles, and processing payment plans. Even the most diligent teams can’t possibly respond to every patient in real time.
Conversational AI has “entered the chat” to fill this gap. AI-enabled billing platforms can now answer patients’ most common questions instantly and accurately: Why is my balance higher than normal? Can I split this into smaller payments? Patients get clear, plain-language explanations whenever they need them, not just during office hours.
When patients understand their bills, they’re far more likely to pay them. The goal isn’t to chase what’s due more aggressively, but instead more effectively by meeting patients where they are with clarity on the communication channels they actually use.
The data already suggest where the future is heading. Patient responsibility now accounts for roughly one fifth of practice revenue, and collection rates are falling year over year. The methods of yesteryear – paper statements, call centers, third-party collectors – belong to an era when insurance covered most of a provider’s income.
In today’s convoluted and continually evolving billing landscape, transparency and convenience aren’t just niceties. For most providers, they’re prerequisites for financial sustainability. At a time when people are questioning not just their bills but the institutions that send them, trust is the currency that matters most. That trust comes from experience. When patients can get clear, quick answers about what they owe and understand their bill in context, it builds confidence that their doctor has their best interest at heart. The better the payment experience, the more patients will believe in the fairness of what they’re paying for.
This much is reflected in patients’ online behavior; they aren’t trying to game the system so much as understand how to navigate it. They’re posing fair questions to Reddit and ChatGPT because they’re the only sources offering fast, plain-language answers. Providers that respond with clarity, empathy, and speed will not only get paid more reliably, but also preserve something even more valuable: the fragile trust that underpins every part of the care experience.
Patients deserve the confidence of knowing they’re being treated fairly. That assurance, and the trust it builds, will remain providers’ most effective collection tool.
Photo: KLH49, Getty Images
Blake Walker is the co-founder and CEO of Inbox Health, a company dedicated to transforming the patient billing experience in healthcare. He has focused his career on design and innovation in the patient billing space and played a pivotal role in developing technologies that simplify medical billing for patients and healthcare providers alike. Under his leadership, Inbox Health has become a trusted partner for more than 3,000 healthcare practices and more than 2 million patients a year and was recently named to the Inc. 5000 list of fastest-growing private companies in America.
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