Most likely because people don't pay their bills. That's unfortunate and everyone needs to remember that your health is most important and you have to pay for services...at the time of service. So be prepared. Most everyone has a cell phone($40-$150/mo) and cable tv ($50-$180mo), internet service ($25-$80mo) some smoke ($5/pack) some drink ($5-50/day) some eat out often ($10-$25/meal) some drink coffee ($2-$6/per drink) soda, energy drinks daily… the list goes on…..

If i just dropped cable and cut back on eating out I personally could save realistically $200+/month! I don't have $200 month in medical expenses so i should be able to pay for my medical. But what if I have an unexpected injury or illness that could be considered catastrophic? Cancer, appendicitis with complications? Well, my out of pocket max for a bronze level plan would be $6,850 (2016) so that equals potentially $570.83/month and then everything covered is paid 100% for the rest of that year. That's not so bad, but what if now i cannot work and pay my other bills … OMG.. it spirals out of control… SO BE PREPARED. Buy insurance, it mitigates the expense, you might get better choice of doctors and care with a private plan too, but know that Medicaid (AHCCCS in AZ) can step in and help if you qualify due to the large claim.

I always tell my clients with insurance do this:

• If you have a deductible and they want all and then some - Just say No, I would like you to bill my insurance before I pay it all to you, I might end up owing the anesthesiologist or the assistant surgeon, or the radiology so I recommend giving them a deposit of a few hundred or whatever you can and let insurance process, reprice it and wait for the EOB Explanation of Benefits from the carrier. Then you should get bills that match your patient responsibility and THEN pay or call and set up payment plans immediately… if you wait, they might not work with you.
• If you have an HSA Plan or FSA - just because you have some funds to pay doesn't mean you should pay all that they want up front… it is the same scenario, you might not owe who you give the deposit to! And if you overpay and get a refund the $$ needs to go back to the HSA or FSA account so you don't get penalized by the IRS! So be careful. Confirm you owe the amount they say with your insurance company..they can review the claim and help confirm the amounts.