> ## Documentation Index
> Fetch the complete documentation index at: https://www.practiceownersguide.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Patient responsibility

> Collecting the patient's share: eligibility checks, estimates, No Surprises Act good-faith estimates, and collections that don't destroy goodwill.

Deductibles keep rising, so the patient's share of your revenue keeps rising.
It is also the hardest share to collect: collection odds drop steeply once
the patient leaves the building.

## Verify eligibility before every visit

Run eligibility (270/271 through your
[clearinghouse](/concepts/clearinghouses-explained) or PM) 1-2 days before the
visit: active coverage, copay, remaining deductible, and whether you're
in-network for that specific plan. Most "patient owes more than expected"
surprises are skipped eligibility checks.

## Estimate before you treat

Quote the patient's share before the work: contracted rate minus what
eligibility says remains on the deductible. For self-pay and uninsured
patients, the **No Surprises Act requires a written good-faith estimate**,
and patients can dispute bills that exceed it by \$400+. Build the GFE into
scheduling for self-pay patients rather than treating it as paperwork.

## Collect at the point of care

The rules that work: copays before the visit, not after. Card-on-file with
signed authorization for balances that adjudicate later
([POS setup](/guides/choose-your-pos)). Deposits for high-ticket elective
work. Payment plans offered proactively at checkout, or third-party
[patient financing](/guides/patient-financing) for large cases.

## Bill fast, escalate gently

Statement within a week of the ERA posting, not month-end. Text or email
with a payment link outperforms paper. A simple ladder: statement, reminder
at 30 days, call at 60, decision at 90 (settle, plan, or small-balance
write-off). Collections agencies recover little and cost goodwill; use them
as policy for large balances, not reflexively.

<Note>
  Waiving copays and deductibles routinely is not a kindness, it's a compliance
  problem (insurance fraud with commercial payers, kickback exposure with
  federal ones). Hardship discounts need a documented policy applied
  consistently.
</Note>

## Related

* [Patient financing](/guides/patient-financing)
* [Choose your POS system](/guides/choose-your-pos)
* [Send patient refunds](/guides/send-patient-refunds)
* [What "reconciled" means](/concepts/reconciliation)