Hit with $7,146 for two hospital bills, a family sought medical attention in Mexico

The Fierro family of Yuma, Arizona had a streak of medical bad luck that began in December 2020.

It was then that Jesús Fierro Sr. was admitted to the 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 the next she was in an ambulance on her way to the same medical center. She was told that her magnesium levels were low and was sent home within 24 hours.

The family has health insurance through Jesus Sr.’s job, but it did not protect 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, opted out of medical care in the US and headed south to the border between USA and Mexico.

And no other bills arrived 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 Jesus Sr.’s employment with NOV, formerly National Oilwell Varco, an American multinational oil company headquartered in Houston.

Medical services: For Jesús Sr., 18 days of hospitalization for a severe case of COVID-19. For Claudia, less than 24 hours of emergency care after fainting. For Jesús Jr., a walk-in for a dislocated shoulder.

Total bills: Jesus Sr. was charged $3,894.86. The total bill was $107,905.80 for COVID-19 treatment. Claudia was charged $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 treatment. Jesús Jr. was charged $5 (70 pesos) for an outpatient visit that the family paid for in cash.

Service Providers: Yuma Regional Medical Center, a 406-bed nonprofit hospital in Yuma, Arizona. He’s in the Fierros’ insurance network. And a private medical office in Mexicali, Mexico, which is not.

What gives: The Fierros were trapped in a situation that more and more Americans find themselves in. They are what some experts refer to as “functionally uninsured.” They have insurance, in this case, through the work of Jesús Sr., which pays $72,000 a year. But his health plan is expensive and do not have liquid savings to pay your portion of the bill. The Fierros’ plan says their out-of-pocket maximum is $8,500 a 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 run-ins with the medical system can eat up virtually all of a family’s available savings, year after year. And that is why the Fierros opted not to receive medical care in the US for their son.

Under the terms of the insurance plan, which has a $2,000 family deductible and 20% coinsurance, Jesus Sr. owed $3,894.86 of a total bill of nearly $110,000 for his COVID-19 care at the end of 2020.

The Fierros are paying that bill — $140 a month — and still owe more than $2,500. In 2020, most insurers agreed to give up cost sharing payments for the treatment of COVID-19 after the approval of the federal law coronavirus relief packages which provided emergency funds to hospitals. But waiving treatment costs was optional under the law. And while Blue Cross and Blue Shield of Texas has a posted policy saying would waive cost-sharing through the end of 2020, the insurer didn’t do that for Jesus Sr.’s bill. Carrie Kraft, an insurer spokeswoman, declined to explain why her bill wasn’t expunged.

(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 charging patients their share of cost-sharing again.)

On January 1, 2021, the Irons’ deductible and out-of-pocket maximum reset. So when Claudia fainted, a fairly common event that rarely indicates a serious problem, she was sent by ambulance to the emergency room, leaving the Fierros with another bill of more than $3,000. That kind of bill is a huge stress for many American families; Less than half of American adults have enough savings to cover a $1,000 surprise spend. in the last Kaiser Family Foundation survey“unexpected medical bills” ranked second among household budget concerns, behind gas prices and other transportation costs.

The new fainting bill destabilized the Fierros’ family budget. “We thought about taking out a second loan for our house,” said Jesus Sr., a Los Angeles native. When he called the hospital to ask for financial assistance, he said, the people he spoke with strongly discouraged him from applying. “They told me I could apply, but it would only reduce Claudia’s bill by $100,” he said.

So when Jesus Jr. dislocated his shoulder while boxing with his brother, the family headed south.

Jesus father asked his son: “Can you bear the pain for one hour?” The teenager replied, “Yes.”

Father and son made the hour-long drive to Mexicali, Mexico, to the office of Dr. Alfredo Acosta.

The Fierros are not considered “health tourists.” Jesús Sr. crosses the border to Mexicali every day for his work, and Mexicali is Claudia’s hometown. For years they have traveled to the neighborhood known as La Chinesca to see Acosta, a general practitioner who treats his youngest son, Fernando, 15, for asthma. The treatment for Jesus Jr.’s dislocated shoulder was the first time they had sought emergency care from a doctor. The price was correct and the treatment effective.

A visit to a US emergency room would likely have involved a setup fee, expensive X-rays, and perhaps a specialist evaluation, leading to thousands of dollars in bills. Acosta adjusted Jesus Jr.’s shoulder so the bones lined up in the socket and prescribed ibuprofen for the pain. The family paid cash on the spot.

Although the Centers for Disease Control and Prevention does not endorse traveling to another country for medical carethe Irons are between million americans every year who does it. Many of them are fleeing expensive care in the US, even with health insurance.

Acosta, who is from the Mexican state of Sinaloa and is a graduate of the Autonomous University of Sinaloa, moved to Mexicali 20 years ago. He witnessed firsthand the growth of the medical tourism industry.

He sees about 14 patients a day (no appointment necessary) and 30% to 40% of them are from the United States. Charges $8 for typical visits.

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 are internationally certified and considered expensive, but are still cheaper than US hospitals.

Resolution: Both Blue Cross and Blue Shield of Texas and Yuma Regional Medical Center refused to discuss the Fierros’ bills with KHN, despite Jesus Sr. and Claudia giving them written permission to do so.

In a statement, Yuma Regional Medical Center spokesman Machele Headington said, “Applying for financial support begins with an application, a service that we extended, and still extend, to these patients.”

In an email, Kraft, the spokesperson for Blue Cross and Blue Shield of Texas, said, “We understand the frustration our members experience when they receive a bill containing COVID-19 charges that they don’t understand or feel may be inappropriate.” .

The Fierros plan to apply to the hospital for financial support for their outstanding debts. But Claudia never said again, “I told Jesus, ‘If I pass out again, please take me home,'” instead of calling an ambulance.

“We pay a monthly premium of $1,000 for our employment-based insurance,” Jesus added. “We shouldn’t have to live with this stress.”

Food to go: Keep in mind that your deductible “meter” starts over every year and that virtually any emergency care can result in thousands of dollars in bills and could leave you owing your deductible and most of your out-of-pocket maximum.

Also note that even if you do not appear to qualify for financial assistance under hospital policy, you may still apply and explain your circumstances. Due to the high cost of care in the US, even many middle-income people qualify. And many hospitals give their finance departments some wiggle room to adjust bills. Some patients find that if they offer to pay cash on the spot, the bill can be dramatically reduced.

All nonprofit hospitals have a legal obligation to help patients: they pay no taxes in return for providing a “community benefit.” Make your case and ask to speak to a supervisor if you get an initial no.

For elective procedures, patients can follow the Fierros’ lead and become savvy health care buyers. Claudia recently needed an endoscopy to evaluate an ulcer. The family called different centers and discovered a difference of $500 in the cost of an endoscopy. They will soon drive to a medical center in Central Valley, California, two hours from home, for the procedure.

The Fierros didn’t even consider going back to their local hospital. “I don’t want to say ‘Hello’ and get a $3,000 bill,” Jesús Sr. joked.

Stephanie O’Neill contributed the audio portrait to this story.

Bill of the Month is a collaborative research conducted by KHN Y NPR that dissects and explains medical bills. Do you have an interesting medical bill that you want to share with us? tell us about it!