Doctor redefines plastic surgery.

It's a common scenario: A patient gets a hefty hospital bill. Without insurance, he can't pay. And unlike insured patients, whose insurers get discounts on hospital services, he's asked to pay the retail cost.

Rusty Salton is a doctor and CEO of Charlotte-based HRA Financial Services Inc., which does business as AccessOne. It offers a solution for uninsured patients--a revolving charge credit card, which allows them to make monthly payments. Most hospitals offering the "MedCard" give participating patients a 20% discount.

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Salton, 56, grew up in Williamson, W.Va., where his grandfather founded a hospital. As a college student, he spent summer mornings in the operating room with his dad and afternoons in the hospital's business office. After graduating from West Virginia University School of Medicine in 1973, Salton did his family-practice residency at Carolinas Medical Center. He stopped practicing in 1990 to form Primary PhysicianCare, a Charlotte-based managed-care company. In '95, he joined Aetna U.S. Healthcare as network medical director for the Carolinas.

Salton bought HRA's AccessOne unit in 2002. When he took over, it had five hospitals as clients. Today it has 14 employees, 42 client hospitals, 14,000 active MedCard accounts and revenue of about $150,000 a month. AccessOne does not run credit checks, so all patients are eligible for the MedCard. The balance can be paid interest-free within 90 days, and there is no annual fee. For longer payment terms, AccessOne charges interest at the prime rate plus 4.5%. On a 36-month, $1,200 bill the monthly payment in early November would have been $39.

Collection agencies charge hospitals 18% to 24% for action on delinquent accounts. AccessOne pays hospitals for patients' bills upfront, charging a 6% fee. When an account is in default--this occurs in one in six accounts--AccessOne bills the hospital for the unpaid principal.

Salton misses helping patients as a physician, but he is happier on the business side of medicine, he says. "Physicians used to just have to answer to the patients' needs. Now they have to answer to the government and insurance companies. Having grown up in a medical family, the idea of a physician not having autonomy is unacceptable to me."