Some know how to work the system and travel from emergency room to emergency room, seeking free medical care. Others are drug addicts, homeless or illegal immigrants who can't be found when it's time to pay the tab.

But more often than not, Utahns who don't pay their medical bills on time want to pay for their care but struggle to afford it, according to hospital administrators and patients.

Utah's four largest hospital systems -- Intermountain Healthcare, University of Utah, MountainStar and Iasis Healthcare -- were owed $259 million in their 2007 fiscal years, a 77 percent jump from five years ago.

Administrators attribute the rise to a growing population, a spike in uninsured patients and an increase in the number of patients who have insurance but cannot afford ever-higher deductibles and insurance copayments. Hospitals expect even more bad debt with the economy in the tank.

"We do run into a lot of people who are in a major medical situation and just don't have the funds to pay for it," said Jason Bradford, vice president of Outsource Receivables, a collection agency that mainly works for hospitals, clinics and doctors. "A lot of it is just people who are living paycheck to paycheck."

He's seen a jump in medical debt turned over to his office in the past six to eight months, noting patients owe on average $380. And he's finding he needs to "push legal action a lot further."

When his agency would garnishee wages in the past, now it puts liens on homes. And he estimates his company has received court orders for six "sheriff's sales," in which constables seize assets and sell them to pay off debt.

From July 2007 to June 2008, the nonprofit University of Utah seized $4 million in income tax returns from patients who had not paid medical bills. It also received judgments worth $500,000 on 69 of that period's 1.15 million accounts. Many more lawsuits were filed against patients whose debt occurred years before.

Nonprofit Intermountain Healthcare does not take people to court. Instead, it reports patient who refuse to pay to credit agencies.

Gordon Crabtree, the U. hospital's chief financial officer, said the U. first determines whether patients qualify for charity care, and if not, provides a 30 percent discount to uninsured patients and offers payment plans.

"If somebody is simply not willing to sit down and work with us on any scenario, that's where they would end up with a judgment," he said.

These patients appeared at recent debt collection hearings in 3rd District Court in Salt Lake City:

Nancy Ballard, 40, » has already been ordered to pay an oral surgeon $2,200. When she showed up to reveal her assets to the collection agency, the Riverton woman said she had nothing to report.

She estimates she owes at least $120,000 to hospitals and doctors for the lifelong complications she's endured from having undiagnosed rheumatic fever as a child.

Ballard said she was laid off from a garage door company earlier this year. She doesn't have a job nor a car. She and her children live in her ex-husband's house. She has no idea how to pay off her debt.

"It's dismal. It's defeating. It's embarrassing," she said. "I'm lucky I have family [to pay for prescriptions and groceries], but I'm sucking them dry."

Kevin Delgado » of Kearns owes almost $800 to anesthesiologists and a clinic for care after his gallbladder "exploded," he said. His offer of $50 monthly installments was rebuffed.

"It ain't like I don't want to pay my bill. Just give me a chance to pay it," said the the 48-year-old plumber, who said he provides for three step-children and eight grandchildren and has health insurance. "Don't take the food out of the kids' mouth. You gotta survive."

Fernando Mendez, 42, » arrived at University Hospital by helicopter after a 2006 car accident and still owes $10,628. Car insurance paid some of the bills, but the Salt Lake City landscaper has no health insurance. He said he couldn't work much after the accident and only made enough money to buy food.

During the court hearing, he and the U. attorney worked out a $50 a month payment plan.

"They're fair enough because they treated me," the Spanish speaker said through his friend, Magdaly Ruiz. But he said he wasn't informed about charity care.

Charlotte Hancey » was robbed of her right breast by cancer. Medical debt will rob her of the chance to have a new one.

The 53-year-old has health insurance, but said she owes $28,000 for her share of mastectomy, chemotherapy and radiation bills from four hospitals.

Jordan Valley Hospital, a for-profit owned by Iasis, sued her for nearly $3,000 and its collection agency wanted $900 a month, she said. She and a mediator agreed to $50 a month. She said she plans to also file for bankruptcy.

"I think it's sad when you have health insurance and you get stuck with $28,000, where if I didn't have any medical insurance they'd just write it off," she said.

She said she can't afford her $3,500 share of reconstruction surgery and wouldn't seek it out when she can't pay her other bills. "I'm just not the same person I used to be."

hmay@sltrib.com