As a retired physician, asking for Copay up front has benefits for the patient and the office. It smooths the check in check out activity. It guarantees that you are not waiting to pay at the end as you might as a restaurant. It also avoids the discussion at the end of the visit as to what credit card or other payment form the office accepts.
Not to mention, the large number of patients who suddenly discover they forgot their wallet or do not have anything smaller than a 100 dollar bill.
As opposed to an escort, the doctor is going to see you or give you a refund. That is not to say that the number of escorts that hit and run is a large one, it is just a larger percentage compared to doctors.
In my office, if you did not pay the copay up front, you were not seen. It is a simple courtesy the patient can offer the office to help make their time more efficient and if there are persons who do no like that or will not be conform to that policy, they were welcome to go elsewhere. When those patients asked to speak to the doctor about this, doubling down as it were, I would come out to the waiting area and ask if they intended to pay the copay at the end and why was it that they would not pay in the manner established for the office. If they said yes they would pay after the services, I would say, well this visit is over, or you can pay the copay now. I have patients to whom I need to attend and I have already spent more time than this should have required. Thanks for your feedback.
Some left and never returned but most opted to pay. How many of those that left would have walked out without payment is unknown but when I instituted this policy, I had more than 25000 dollars in unpaid copays. That number went down to about 12000 dollars when I closed the office for good. It also eliminated patients who felt they were somehow entitled to more than just the medical care. And this happened in the days of $5 and $10 copays. The ritzier the zip code, the more likely they were going to flake on the copay on a percent basis.