The LBJ hospital in American Samoa is facing criticism over its decision to increase fees for non-residents.
The new charges at the financially troubled hospital will mean most outpatient clinic costs will double to 20 US dollars a visit.
But our correspondent, Monica Miller, says non-residents pay 10 dollars, but that fee will increase to 105 - with $85 of that paid after treatment.
She says there has been criticism that it could be unconstitutional to favour one section of the population.
"The private sector relies on foreign employees, particularly the canneries, and the way the immigration process is, if you're allowed to come here for one year and work, at the end of one year, you have to renew your immigration ID, and before you can renew the ID, you have to clear all your hospital bills, or you can't get renewal."
Monica Miller reporting from Pago Pago.