Unemployed residents without health insurance have accrued a $4.5 million debt at King Edward VII Memorial Hospital.Staff in the hospital’s credit department are now working to claw back what cash they can, with the remainder to be “written-off as bad debts”, a Bermuda Hospitals Board spokeswoman said.“The [amount owed] has fluctuated somewhat over the last few years — from as high as $7.5m in December 2009 to $2.2m in December 2011 [however] BHB’s credit department has changed ... making it more effective at collections and better able to work proactively with individuals on repayment plans,” she said.Approximately 98 percent of the total debt is owed by patients with no insurance at all.The spokeswoman couldn’t say how many people were involved and said it “would be difficult to determine” whether or not the number had risen in recent years.“To understand the dynamics we would need to consider increases in the number of people who are unemployed but have sought coverage from government,” she said.When it’s deemed impossible that the cash will be recovered, bills have historically been “written-off as bad debts”.Included in that stack are bills incurred by individuals serving life or lengthy prison sentences for violent crime.Said the spokeswoman: “We do not do an account of how much of the hospital’s outstanding debt is attributed to uninsured individuals who are now incarcerated.“However, it should be noted that while in prison, an individual’s healthcare costs are paid by government.”With hundreds of people summoned to court each week for non-payment of bills, the spokeswoman said it was important that people understand their payment options.“If you are unemployed/underemployed and do not have funds for private insurance, you can get indigent status or HIP,” she said.“People can apply for indigent status or apply to [the Department of] Financial Assistance for healthcare coverage. You don’t need to personally incur hospital bills and end up in court.”The requirements for indigent status are set out under the Health Insurance Act, 1970, the spokeswoman said. Residents can apply through the BHB credit office.“The hospital does work with individuals [on] payment plans to make repayment more affordable,” she added. “And affordable healthcare coverage is available through the Health Insurance Department.”The BHB also provides special payment arrangements for those who have incurred hospital bills they cannot afford to pay.“This allows users an opportunity to pay for their services over a period of agreed times to ease the financial burden and avoid any credit-related court action.”