Lisa Hornak for Kaiser Health News
The Fierro family from Yuma, Arizona had a streak of medical bad luck that began in December 2020.
It was then that Jesús Fierro Sr. was admitted to hospital with a serious case of COVID-19. He spent 18 days at Yuma Regional Medical Center, where he lost 60 pounds. He came home weak and dependent on an oxygen tank.
Then, in June 2021, his wife, Claudia Fierro, passed out while waiting for a table at the local Olive Garden restaurant. She felt dizzy one minute and was in an ambulance en route to the same medical center the next day. She was told her magnesium was low and was sent home within 24 hours.
The family has health insurance through the work of Jesús Sr., but that didn’t stop the Fierros from owing thousands of dollars. So when their son Jesús Fierro Jr. dislocated his shoulder, the Fierros — who had yet to pay the bills for their own care — gave up American health care and headed south to at the US-Mexico border.
And no other bills came for at least one family member.
The patients: Jesus Fierro Sr., 48; Claudia Fierro, 51; and Jesús Fierro Jr., 17. The family has Blue Cross and Blue Shield of Texas health insurance through Jesús Sr.’s employment with NOV, formerly National Oilwell Varco, an American multinational oil company based in Houston.
Medical services: For Jesús Sr., 18 days of hospital care for a serious case of COVID-19. For Claudia, less than 24 hours of emergency care after fainting. For Jesús Jr., a walk-in appointment for a dislocated shoulder.
Total invoices: Jesús Sr. was billed $3,894.86. The total bill was $107,905.80 for COVID-19 treatment. Claudia was billed $3,252.74, including $202.36 for treatment by an out-of-network doctor. The total bill was $13,429.50 for less than one day of processing. Jesús Jr. was charged $5 (70 pesos) for an outpatient visit which the family paid for in cash.
Service providers: Yuma Regional Medical Center, a 406-bed nonprofit hospital in Yuma, Arizona. He is part of the Fierros insurance network. And a private medical practice in Mexicali, Mexico, which isn’t.
Which give: The Fierros were trapped in a situation that more and more Americans find themselves in. They are what some experts call “functionally uninsured”. They have insurance – in this case, thanks to the work of Jesús Sr., who pays $72,000 a year. But their health plan is expensive and they don’t have the cash savings to pay their part of the bill. The Fierros’ plan says their maximum outlay is $8,500 per year for the family. And in a country where even a short stay in an emergency room is billed at a staggering sum, that means minor encounters with the medical system can take virtually all of a family’s available savings, year after year. And that’s why the Fierros opted out of US health care for their son.
Under the terms of the insurance plan, which provides a $2,000 family deductible and 20% coinsurance, Jesús Sr. owed $3,894.86 out of a total bill of nearly $110,000 for his COVID-19 care. end of 2020.
The Fierros pay that bill — $140 a month — and still owe more than $2,500. In 2020, most insurers agreed to waive cost-sharing payments for COVID-19 treatment after the passage of federal coronavirus relief programs that provided emergency funding to hospitals. But waiving the processing fee was optional under the law. And although Blue Cross and Blue Shield of Texas have a published policy that they will waive cost sharing through the end of 2020, the insurer did not do so for Jesús Sr. Carrie Kraft’s bill, spokesman for the insurer, would not explain why his bill had not been canceled.
(More than two years into the coronavirus pandemic and with vaccines now widely available to reduce the risk of hospitalization and death, most insurers are once again charging patients their share of the cost share.)
On January 1, 2021, the Fierros’ maximum deductible and payout were reset. So when Claudia passed out – a fairly common occurrence and rarely indicative of a serious problem – she was rushed to the ER by ambulance, leaving the Fierros with another bill of over $3,000. This kind of bill is a huge stress for many American families; less than half of American adults have enough savings to cover a surprise $1,000 expense. In a recent survey by the Kaiser Family Foundation, “unexpected medical bills” ranked second among family budget worries, behind gas prices and other transportation costs.
The new fainting bill has destabilized the Fierros’ family budget. “We thought about getting a second loan for our house,” said Los Angeles native Jesús Sr. When he called the hospital to ask for financial aid, he said, the people he spoke to strongly discouraged him from applying. “They told me I could apply but it would only cut Claudia’s bill by $100,” he said.
So when Jesús Jr. dislocated his shoulder boxing with his brother, the family headed south.
Jesús Sr. asked his son: “Can you bear the pain for an hour? The teenager replied, “Yes.”
Father and son made the hour-long trip to Mexicali, Mexico, to Dr. Alfredo Acosta’s office.
The Fierros do not consider themselves “health tourists”. Jesús Sr. crosses the border with Mexicali every day for his job, and Mexicali is Claudia’s hometown. They have been traveling to the neighborhood known as La Chinesca (Chinatown) for years to see Acosta, a general practitioner, who is treating the asthma of their youngest son, Fernando, 15. The treatment for Jesús Jr.’s dislocated shoulder was the first time they sought emergency treatment from the doctor. The price was right and the treatment effective.
A visit to a US emergency room would likely have involved facility fees, expensive x-rays and possibly an evaluation by a specialist – which would have generated thousands of dollars in bills. Acosta adjusted Jesús Jr.’s shoulder so the bones were aligned in the socket and prescribed him ibuprofen for the pain. The family paid cash on the spot.
Although the Centers for Disease Control and Prevention does not endorse travel to another country for medical care, the Fierros are among millions of Americans who do so each year. Many of them are fleeing expensive care in the United States, even with health insurance.
Acosta, originally from the Mexican state of Sinaloa and a graduate of the Autonomous University of Sinaloa, moved to Mexicali 20 years ago. He has witnessed firsthand the growth of the medical tourism industry.
He sees about 14 patients a day (no appointment necessary), and 30-40% of them are from the United States. It charges $8 for typical tours.
In Mexicali, a mile from La Chinesca, where family doctors have their modest offices, there are medical facilities that rival those in the United States. The facilities have international certification and are considered expensive, but they are still cheaper than hospitals in the United States.
Resolution: Blue Cross and Blue Shield of Texas and Yuma Regional Medical Center declined to discuss the Fierros’ bills with KHN, even though Jesús Sr. and Claudia gave them written permission to do so.
In a statement, Yuma Regional Medical Center spokesperson Machele Headington said: “The request for financial assistance begins with an application – a service that we have extended and are still extending to these patients.”
In an email, Kraft, the spokesperson for Blue Cross and Blue Shield of Texas, said, “We understand the frustration our members feel when they receive an invoice containing COVID-19 charges that they don’t understand. not or which they deem inappropriate.”
The Fierros consider asking the hospital for financial support for their outstanding debts. But Claudia never again said, “I said to Jesús, ‘If I pass out again, please take me home,’ rather than calling an ambulance.
“We pay a monthly premium of $1,000 for our employment-based insurance,” Jesús added. “We shouldn’t have to live with this stress.”
Take-out: Be aware that your deductible “counter” starts over every year and virtually any emergency treatment can generate a bill of several thousand dollars and may require you to pay your deductible and most of your maximum disbursements.
Also be aware that even if you appear to be ineligible for financial assistance under a hospital’s policy, you can submit a request and explain your situation. Due to the high cost of care in the United States, even many middle-income people are eligible. And many hospitals give their financial departments leeway to adjust their bills. Some patients find that if they offer to pay cash on the spot, the bill can be significantly reduced.
All non-profit hospitals have a legal obligation to help patients: they pay no taxes in exchange for a “community benefit”. Show off and ask a supervisor if you get a first no.
For elective procedures, patients can follow the Fierros’ lead and become savvy purchasers of healthcare. Recently Claudia needed an endoscopy to assess an ulcer. The family called different facilities and discovered a $500 difference in the cost of an endoscopy. They will soon drive to a medical center in Central Valley, Calif., two hours from their home, for the procedure.
The Fierros didn’t even consider returning to their local hospital. “I don’t want to say ‘Hello’ and get a $3,000 bill,” joked Jesús Sr.
Stephanie O’Neill contributed to the audio portrait with this story.
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