It is hard to collect deductibles and/or coinsurance up front because you really cannot be 100% sure of the amounts until the claim is processed. For instance, a patient may have a deductible but another provider's claim may get processed before yours causing the deductible to be met, and creating an overpayment. With co-insurance, the allowed amounts vary so much from plan to plan, and also change periodically, so again, hard to know for sure ahead of time. However if you have a specialty such as mental health where the patient is coming in regularly with the same insurance for the same code/services, you can be pretty sure of the coinsurance and charge up front. I don't like to have situations where there are overpayments since that creates another mess!