It's hard to charge the patient up front because:
1. You don't know what the allowed amount for the services will be (unless you are billing something that you bill routinely to the patient's insurance so it's been definitively established)
2. Another provider's claim may get processed ahead of yours to meet the deductible and then payment may get made. Unless the patient has a large deductible this is quite common.
So if the provider collects money up front they may end up owing the patient a refund.
