WASHINGTON COUNTY, Tenn. -

If you need surgery, you may now have to pay for it before the procedure ever starts. Two major healthcare providers in our region are changing the way they charge for some surgeries.

Both Wellmont Health System and Mountain States Health Alliance are starting a prepay system for some of their surgeries. The new policy began September 3, but hospital officials said the need for it stems from problems that have multiplied in the past few years.

Get well now; get a bill for it later. That's how surgery used to work.

"If you got to have it, you're going to have to pay it, you know," said local resident Janice Blevins.

But we discovered all patients at Mountain States Health Alliance and Wellmont Health System are now required to pay half their tab that's not covered by insurance up front for elective surgeries.

According to a letter sent to Mountain States Health Alliance physicians, the need to pay up front comes from a dramatic increase in the number of patients who haven't been able to pay. In fact, we learned Mountain States had $167 million worth of uncompensated care for fiscal year 2012. Wellmont paid out $75 million that same year.

In a statement, Wellmont officials told News 5, "to continue meeting this growing community need, Wellmont needs to remain [a] good steward of its financial resources. That has led Wellmont Health System to adopt a policy revision that requires patients to prepay half of their out-of-pocket expense for elective procedures."

News 5 asked people who may need elective surgery in the future how they feel about the new policy.

"You go to the doctor's office, you pay a deductible. You go to the emergency room, you pay a deductible, but if I had to go in for some kind of surgery and had to pay half of what the insurance didn't pay, I probably couldn't do it," said Shirley Booher, a local resident.

Diane Pilkenton who said she already pays a high insurance premium feels the same way.

"To have to go and pay half out of my pocket besides that is a little bit hard to handle, especially in these times," Pilkenton said.

Meanwhile we learned surgery could be delayed if you can't pay under this new policy, so planning to prepay could be the new normal.

"[I'll] save up for it you know, just like everything else," said Janice Blevins.

Both Wellmont and Mountain States officials both emphasize this is just for elective procedures. Emergency surgeries will be given regardless of a patient's ability to pay, and the new policy will not increase a patient's out-of-pocket expense.

We're also told this payment structure has been in place for uninsured patients for years.