Whether it’s paying out of pocket for treatment or for insurance premiums, co-payments or deductibles, many consumers are paying more for healthcare. By 2019 consumers will pay about $608 billion out of pocket on healthcare services or about 18% of annual healthcare spending of $3.40 trillion, says healthcare payments processor InstaMed.

As they pay more for healthcare, consumers want more detail from providers and payers about what they are paying for and more options to pay online, says a new survey of about 3,0000 consumers from InstaMed. For example, 92% of consumers want to know what portion of a doctor visit or treatment they may owe prior to seeking care. Many aren’t getting the information they need: 74% of consumers say they are confused by the medical bills and explanation of benefits they receive from providers and insurance companies.

“Consumers are only aware that they may have payment responsibility after they seek healthcare services when they are sent an explanation of benefits by their health plan,” says the InstaMed report. “Though it discusses payment responsibility, the explanation of benefits typically includes bold language that it is not a bill and should not be paid by the consumer and this mixed messaging maybe one of the reasons consumers are confused.”

Consumers also want to receive less paper from healthcare payers and providers, and to have more ways to pay online. Specifically, 86% of consumers receive paper medical bills and 80% of consumers want to pay their bill online by debit card, credit card, electronic check and other paperless forms of payment.

“Consumers do not view healthcare as different from other industries,” the InstaMed report says. “Consumers want multiple ways to pay all of their healthcare premiums just as they do for their household bills—from paying online to making payments through their bank’s bill pay site.”

Other findings from the InstaMed report include:

• 20% of online consumer payments for healthcare bills were made through a mobile device in 2016 compared with 18% in 2015 and 5% in 2012.
• 61% of consumers are interested in using Apple, Samsung or Google Pay to make a healthcare payment.
• 58% of consumers prefer automatic deduction from their bank account to pay an insurance premium.

“Right now consumers expect Amazon-like experiences, but 86% of consumers still receive a paper medical bill and only 21% actually want to use paper checks to make healthcare payments,” the report says.