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 COVID-19 infection. 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, passed out while waiting for a table at the local Olive Garden. 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.
Invoice of the month | In one look
The patients: Jesus Fierro Sr., 48; Claudia Fierro, 51; and Jesús Fierro Jr., 17. The family has Blue Cross Texas Blue Shield health insurance through Jesús Sr.’s employment with NOV Inc., formerly National Oilwell Varco, a multinational oil company.
Medical services: For Jesús Sr., 18 days of hospital care for severe COVID infection. 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 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 about $5 (70 pesos) for an outpatient visit which the family paid for in cash. Family bills can be seen here.
Service providers: Yuma Regional Medical Center, a 406-bed nonprofit hospital in Yuma. It’s in the Fierros insurance network. And a private medical practice in Mexicali, Mexico, which isn’t.
Which give: The Fierros have been 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 insurance plan is expensive and they I have no cash savings pay their “share” 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 pulled out.
Under the terms of the insurance plan, which provides a family deductible of $2,000 and coinsurance of 20%, Jesús Sr. owed $3,894.86 out of a total bill of nearly $110,000 for his COVID care at the end of 2020.
The Fierros pay that bill — $140 a month — and still owe more than $2,500. In 2020, most insurers have agreed to waive cost-sharing payments for COVID-19 treatment after passage of federal law COVID relief packages which provided emergency funding to hospitals. But waiving the processing fee was optional under the law. And although Blue Cross Blue Shield of Texas has a published policy saying he would waive cost sharing until the end of 2020, the insurer did not do so for Jesús Sr.’s bill. Carrie Kraft, a spokeswoman for the insurer, would not explain why his COVID invoice has not been cancelled.
(More than two years into the pandemic and with vaccines now widely available to reduce the risk of hospitalization and death, most insurers are once again charging patients their 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 on the average American family; less than half of American adults have enough savings to cover a surprise expense of $1,000. In a recent survey by the Kaiser Family Foundation“unexpected medical bills” rank 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 reduce Claudia’s bill by $100.”
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 area 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 had sought emergency care 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 an orthopedic 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 carethe Fierros are among million americans every year who do. 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 appointments 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, 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.
Blue Cross 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 spokeswoman Machele Headington said, “The request for financial support begins with a request – a service that we have extended and continue to extend to these patients.
In an email, Kraft, the spokesperson for Blue Cross 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 said never again. “I said to Jesús, ‘If I pass out again, please take me home’” rather than calling an ambulance, she said.
“We pay a premium of $1,000 per month for our employment-based insurance,” Jesús added. “We shouldn’t have to live with this stress.”
The take-out sale
Be aware that your deductible “meter” starts over every year, and virtually any emergency treatment can generate a bill of thousands of dollars and can leave you owing most of your deductible and maximum disbursement.
Also know that even if you don’t appear to be eligible 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”. Argue 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.
Paula Andalo is ethnic media editor for Kaiser Health News, a national newsroom that produces in-depth journalism on health issues. It is supported by the non-profit Kaiser Family Foundation. Bill of the Month is a participatory survey conducted by KHN and NPR who dissects and explains medical bills. Additional stories on the bill of the month can be read here.