The State of
Patient Collections.
We analyzed 1.9 million patient-owed claims to understand what's actually happening with collections as practices adopt more tools to capture patient revenue.
Where the uncollected
dollars are.
Deductibles are 25% of the insured claims that go unpaid but 56% of the uncollected dollars. Copays are the mirror image: 49% of the unpaid claims, 25% of the dollars. Of the $88.1M in insured cost-share liability, $15.7M goes uncollected, and the problem sits in a small number of high-balance deductible claims rather than spread evenly across the book.
| Metric | Value |
|---|---|
| Claims analyzed (N) | 1,900,805 |
| 6-month collection rate | 70.3% |
| Practice-level range | 30.6% – 97.9% |
| Practice-level median | 77.5% |
| Practice-level IQR (P25–P75) | 66.0% – 87.5% |
| Median collectable per claim | $30 |
| Mean collectable per claim | $68 |
After day 60,
the curve flattens.
For every dollar a patient owes, the collection curve answers: when? The answer is front-loaded. The average practice has already collected 20% by the time the first bill posts. 62% within 30 days. 68% within 60. From day 61 to day 180, the marginal return is under 7 cents on the dollar. The shape holds across all 35 practices.
What patients owe determines
whether they pay.
Copays collect at 89%. Deductibles at 78%. Coinsurance at 73%. Balance size compounds the effect: the $0–$50 bucket collects at 90%, while $1,000+ claims collect at 35%. Copays hold near 90% up to $75, then fall steadily. Claims over $1,000 are 0.4% of volume and lose almost two-thirds of their value.
The $251–$1,000 zone (62–63% collection) is where payment-plan intervention has the highest return: balances large enough to matter, but not so large that patients have already received financial counseling. Collecting any portion of a balance upfront establishes a payment relationship that changes downstream behavior.
Deductible patterns vary more
by specialty than by year.
Across all practices, deductibles hold a steady 42–48% of cost-share liability, but that aggregate hides real movement at the specialty level. OB/GYN saw deductible share grow 11 percentage points since 2019, while dermatology and gastroenterology moved the other way. Deductible claims are 5x a copay claim by average balance and collect slower at every time horizon. Every January, reset deductibles spike to 64% of cost-share liability, concentrating dollars in the slowest-collecting category. Those January claims still collect at the highest rate of the year.
Collection rates climbed
9 points, then gave back 4.
The aggregate collection rate rose from 65% in 2019 to 74% in 2023, then fell to 70% by 2025 as larger and lower-collecting practices joined the dataset. Coinsurance saw the largest gain of any cost-share type, rising 36 points from 37% to a 73% peak in 2024. Copay rates held near 90% across all years. Q1 collection runs 5 to 6 points above the rest of the year, but the composition shift concentrates dollars in the slowest-collecting category.
| Period | Avg balance | Deductible share | 6-mo rate |
|---|---|---|---|
| Q1 2024 | $75.18 | 57.9% | 77.0% |
| Q2–Q4 2024 | $66.22 | 40.7% | 71.6% |
| Q1 2025 | $74.79 | 57.5% | 74.5% |
| Q2–Q4 2025 | $65.56 | 40.0% | 68.6% |
Q1 outperforms the rest of the year in both years: 77.0% against 71.6% in 2024, and 74.5% against 68.6% in 2025. Both years are fully mature against the 180-day window. Q1 carries the harder book on both counts, a $9 higher average balance and a deductible share of 58% against 40%, and still collects 5 to 6 points better. Patients expect the January charge.
Past behavior predicts
future payment.
Patients who have previously paid all claims collect at 84%. One prior default drops the rate to 63%. The effect compounds: patients with $250+ in cumulative prior unpaid balances collect at just 43% on new claims, a 42-point drop from those with clean histories. Among patients who still owed anything at six months, the top 1% hold 34% of the uncollected balance.
Patient collections pose a bigger challenge
for some specialties, and CPTs.
Dermatology collects at 98%. Gastroenterology, the largest specialty by dollar volume, collects at 67%. Within every category, the spread between individual practices dwarfs the group average.
Half of uncollected dollars go to
collection agencies.
When internal follow-up fails, the default path is external collections. Half of uncollected patient dollars are written off to third-party agencies, which recover an estimated 25–40% of face value. This is the most expensive dollar a practice collects. The 70.3% rate does not include what agencies recover; it measures only what the practice collects internally.
What the data
says.
The first 60 days are everything.
Intervene by balance size, not by days outstanding.
Build a January playbook.
Coinsurance is the least collected, least understood cost-share type.
The deductible shift is specialty-dependent.
Collection rates climbed 9 points since 2019, then gave back 4.
29.7% of patient liability remains uncollected at six months.
Break the balance-fatigue spiral.
How to read
this report.
The dataset
35 Athena tablespaces covering 33 organizations across 44 states. One health system contributes three tablespaces (Tennessee, Utah and Virginia), which are reported separately because they bill and collect separately. 1,900,805 claims with patient liability in CY 2025, as of the 24 August 2026 data pull. The dataset grew nearly 6x since 2019 as practices onboarded. Aggregate metrics use the CY 2025 cross-section; year-over-year trends use all active departments.
Self-pay & uninsured claims
Parts 1 through 8 measure collection on insured patient cost-share: copays, deductibles, and coinsurance assigned by insurance through the TRANSFERIN transaction. Self-pay claims, where the patient owes the full charge with no insurance cost-share assignment, are excluded from those analyses. The two populations differ in balance size (3.4x higher for self-pay), collection workflow (no EOB-driven posting timeline), and patient expectation (no payer-negotiated rate). Combining them would obscure both stories.
Self-pay represents 4.7% of claims but 14.4% of patient liability in CY 2025. Self-pay identification uses the absence of a TRANSFERIN (cost-share assignment) transaction, which may capture patients whose insurance was expected but never posted, not just true uninsured patients. This makes the self-pay population noisier than the insured cohort. What follows is a standalone profile.
| CY 2025 | Insured | Self-pay |
|---|---|---|
| Claims | 1,810,993 (95.3%) | 89,812 (4.7%) |
| Patient liability | $110.6M (85.6%) | $18.6M (14.4%) |
| 6-month collection rate | 73.0% | 54.0% |
| Average balance | $61 | $207 |
| Median balance | $27 | $100 |
| Sent to collections | 128,175 · $14.3M | 14,577 · $3.9M |
| Other write-offs | 36,877 · $4.8M | 15,144 · $3.5M |
| Write-off exposure | 17.3% of liability | 40.1% of liability |
Self-pay collection has moved between 52% and 63% since 2019 with no trend. Insured cost-share climbed from 67% to 73% over the same period, so the gap widened from 10 points to 19. Self-pay balances average $207 against $61 for insured cost-share, and 40% of self-pay liability ends up written off against 17% of insured. Self-pay carries no EOB to explain the amount, so the two populations behave differently at every stage.
Methodology
Collection rate calculation. Per-claim collectable = TRANSFERIN + CHARGE + TRANSFEROUT + ADJUSTMENT (excluding COLLECT and OTHER adjustment reasons), floored at zero. Per-claim collected = patient PAYMENT (negated), capped at collectable. Collection rate = sum of collected / sum of collectable across all claims in the population. This methodology is applied consistently across every chart in this report.
Time windows. Primary analyses use a 180-day window from claim service date, measured by payment post date. The collection-curve analysis measures cumulative payments at day 0, 3d, 7d, 14d, 30d, 60d, 90d, 120d, and 180d. "Day of service" uses payment postdate ≤ claimservicedate to capture point-of-service collection.
Why exclude COLLECT/OTHER adjustments. COLLECT and OTHER are negative adjustment categories that typically represent write-offs to external collection agencies or administrative write-offs. Including them in the collectable formula would shrink the denominator and inflate collection rates. Excluding them keeps written-off balances in the denominator, meaning the rate reflects what was actually collected from patients relative to total patient liability.
Aggregate vs practice-level rates. Aggregate collection rates are dollar-weighted: total collected divided by total collectable across all claims. When practice-level variation is reported, each practice's rate is calculated independently. The collection curve uses practice-average methodology: each practice's rate at each time window is calculated independently, then averaged across all 35 practices, weighting each practice equally regardless of size. Sample sizes are flagged throughout (N=).
Same-store comparisons. Year-over-year cost-share composition (Chart 9B) uses a same-store cohort: only practices with patient-liability data in both 2019 and 2025. This controls for the effect of new practice onboarding, which would otherwise distort share trends. The denominator for cost-share composition is copay + deductible + coinsurance TRANSFERIN dollars only (excluding Other/Self-pay), so shares sum to 100% across the three categories. Where two practices share a specialty, their shares are averaged.
Limitations
- Single-EHR platform. All data is sourced from Athena. Practices on other systems may exhibit different transaction patterns or collection workflows.
- Selection bias. The 35 practices elected to work with a patient collections platform; they may differ from non-participating practices in operational maturity.
- Small N for subgroup analyses. Many specialty categories (N=1–2 practices); directional only.
- No patient demographics. All analyses use de-identified patient claims data. Age, income, insurance tier, and geographic density are unavailable.
- Care setting is mixed. The population includes hospital-based professional fees from one health system's physician practices. Those claims collect at 10 to 19% and pull the aggregate down; the office and ambulatory subset collects at 70.5%.
- Cost-share allocation. Patient payments are not tagged by cost-share type. Cost-share-specific rates classify claims by dominant TRANSFERIN reason; payments are attributed to the claim, not the specific cost-share category.
Source tables
| Table | Schema | Purpose |
|---|---|---|
transaction | prod_core.base_athena | Charges, payments, transfers, adjustments |
claim | prod_core.base_athena | Service date, patient, department |
department | prod_raw.raw_athena | Department specialty (one multi-specialty practice) |
provider | prod_core.base_athena | Specialty, taxonomy, type |
claims_with_srt | prod_edw.entities | Procedure code, plan type, payer |
Key filters: voideddate IS NULL on all transaction queries. transactiontransfertype = 'Patient' isolates the patient financial responsibility bucket. Adjustment transactions with reason COLLECT or OTHER are excluded from the collectable formula to avoid deflating the denominator with write-offs.