You may need to cover more than your co-pay at your next doctor's appointment. Some doctors tired of waiting to get paid are collecting up front.

For example, when Pat Andre recently made an appointment to see her doctor, she was told she'd be paying extra. Insurance only covers some of the bill, and her doctor wanted the rest of it before he treated her.

"If you don't have the money, you don't get the care," Pat says.

That's becoming more common. A recent survey found more than half of doctors collect the entire portion up front for things like surgery or scans. That concerns patient advocates like Karen Stoll.

"It can be a serious issue for consumers who need to see the doctor," Stoll warns.

But it might be necessary. Recent statistics show when bills are sent after treatment, doctors typically only get half the money! So now, some doctors are requiring patients to pay everything-- even the stuff that insurance would cover. Dr. Dolores Kent is one of those doctors.

"We also do tell them they can send the bill to their insurance company, the patient will get reimbursement by the insurance company for their visit at whatever contract amount has been negotiated with the insurance company," Dr. Kent explains.

She says her new policy has lost her patients. "Some patients go elsewhere. Some patients don't really hear it or understand it on the phone and they actually get to the front desk and they are appalled, outraged amazed," Dr. Kent admits.

Dr. Kent believes her policy actually helps her patients, because she doesn't have to waste time trying to collect from insurance companies. "Here I get a chance to listen to my patients, and talk to my patients and that has a huge effect not only on my patient relationship, but also on my ability to treat the patient, diagnose them," Dr. Kent says.

But what if you can't afford to pay it all up front?

"You have the right to negotiate with your doctor to see what terms he might be willing to offer you. I encourage patients to do that," Dr. Kent says.

Many doctors are willing to negotiate, and hospitals will often set up interest-free payment plans for outstanding bills.