A visitor from Korea with a brain bleed that resulted in more than $35,000 of medical bills is one of many foreign patients that owes the Northland District Health Board more than $144,000.
However, at the end of last year that figure was even higher, with an Official Information Act request showing the DHB was owed $189,866 by foreign patients.
Nationally district health boards have to write off millions of dollars each year of bad debt from foreign patients.
At a board meeting last month the DHB was forced to write off more than $45,854 of that debt because patients had refused to pay, leaving $144,012 outstanding.
During the meeting, board chairman Anthony Norman called the situation an "internal dilemma" as they were bound to provide care but obviously patients did not always pay for the care.
Northland DHB chief executive Nick Chamberlain said if payment had not been received upon discharge, staff would follow up with patients.
"The majority of non-eligible patients have insurance cover or settle their accounts," Dr Chamberlain said.
If no payment or payment plan was received after three months it was referred to a debt collection agency. Immigration New Zealand was also advised of the debt.
Of the top five largest bills owing to the DHB by foreign patients at the end of last year, three were slowly being paid off while two had to be written off.
The Korean patient who had the largest bill presented in April 2009 with a brain bleed. The patient had been making small auto payments each week directly to the Northland DHB and now owed $35,350, though the initial amount was likely much higher.
The second largest bill was from a German patient who suffered a stroke in November 2012 costing $29,609. Despite still being in the country, the patient had their debt written off at the last board meeting.
An Indian patient, who was also still in the country, suffered a heart attack in December 2012 costing $23,941. The patient was making regular weekly payments to a debt collection agency after it was referred by the DHB.
A Chilean patient who presented with a heart attack in June 2014 had their debt of $11,239 written off at the last board meeting. A patient from the US had a brain bleed in November 2014 costing them $10,804, which they had since paid in full.
While the government foots the bill for Kiwis, foreign patients have to fill out an eligibility form when they present at a hospital.
Some countries like Australia or the United Kingdom have reciprocal agreements where the patient's treatment would be covered, while others were covered under their visa status. Foreign patients presenting as a result of an injury may also be covered by ACC.
Acting director of DHB Performance in the National Health Board of the Ministry of Health, John Hazeldine, said DHBs were responsible for recovering debts from non-eligible patients.
"The Ministry recognises that this is not always possible and compensates DHBs with a higher level of debt write-off through its funding," Mr Hazeldine said.