The Fierro Family of Yuma in Arizona had bad luck beginning in December 2020.
That’s when Jesús Fierro Sr. was admitted to the hospital with a serious covid-19 infection. He spent 18 days in Yuma Regional Medical Center and lost 60 pounds. He returned home weak and dependent on oxygen tanks.
Claudia, his wife fainted as she waited for a table at the Olive Garden in June 2021. She felt dizzy, and she was in an ambulance the next to reach the same medical center. She was informed her magnesium levels were low, and she was sent home within 24hrs.
The family has health insurance through Jesús Sr.’s job. But it didn’t protect the Fierros from owing thousands of dollars. So, when their son Jesús Fierro Jr. dislocated his shoulder, the Fierros — who hadn’t yet paid the bills for their own care — opted out of U.S. health care and headed south to the U.S.-Mexico border.
There were no additional bills for at least one family member.
The Patients Jesús Fierro Sr., 48; Claudia Fierro, 51; and Jesús Fierro Jr., 17. The family has Blue Cross Blue Shield of Texas health insurance through Jesús Sr.’s employment with NOV Inc., formerly National Oilwell Varco, a multinational oil company.
Services For Jesús Sr., 18 days of inpatient care for a severe covid infection. Claudia received less than 24 hours of emergency treatment after fainting. For Jesús Jr., a walk-in appointment for a dislocated shoulder.
Total Bills: Jesús Sr. was charged $3,894.86. The total cost of covid treatment was $107,905.80. Claudia was charged $3252.74, which included $202.36 for treatment by an out-of network physician. The total cost was $13,429.50 for less that a day of treatment. Jesús Jr. was charged about $5 (70 pesos) for an outpatient visit that the family paid in cash.
Service Providers Yuma Regional Medical Centera non-profit hospital with 406 beds located in Yuma Arizona. It’s in the Fierros’ insurance network. And a private doctor’s 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 term “functionally uninsured.” They have insurance — in this case, through Jesús Sr.’s job, which pays $72,000 a year. Their health plan is expensive and they don’t have the money to pay for it. don’t have the liquid savings to pay their “share” 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 encounters with the medical system can take virtually all of the family’s disposable savings, year after year. And that’s why the Fierros opted out.
According to the terms of the insurance plan, which has a $2,000 family deductible and 20% coinsurance, Jesús Sr. owed $3,894.86 of a total bill of nearly $110,000 for his covid care in late 2020.
The Fierros are paying off that bill — $140 a month — and still owe more than $2,500. Most insurers will waive this obligation in 2020. cost-sharing paymentsAfter the passage of federal legislation, covid-19 treatment may be available covid relief packagesThat provided emergency funding to hospitals. However, the law allowed for waivers of treatment costs. Blue Cross Blue Shield of Texas does not offer a waiver of treatment costs. posted policy saying it would waive cost sharing through the end of 2020, the insurer didn’t do that for Jesús Sr.’s bill. Carrie Kraft, a spokesperson for the insurer, wouldn’t discuss why his covid bill was not waived.
(More that two years after the pandemic, and with vaccines now widely accessible to reduce the risk for death, many insurers continue to charge patients their cost sharing.
On Jan. 1, 2021, the Fierros’ deductible and out-of-pocket maximum reset. So when Claudia fainted — a fairly common occurrence and rarely indicative of a serious problem — she was sent by ambulance to the emergency room, leaving the Fierros with another bill of more than $3,000. This kind of bill is very stressful for American families. Only half of Americans have enough money to cover it. surprise $1,000 expense. In recent polling by KFF, “unexpected medical bills” ranked second among family budget worries, behind gas prices and other transportation costs.
The new bill for a fainting spell destabilized the Fierros’ household budget. “We thought about taking a second loan on our house,” said Jesús Sr., a Los Angeles native. When he called the hospital for financial assistance, he stated that people he had spoken to strongly discouraged him. “They told me that I could apply but that it would only lower 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 teen replied, “Yes.”
Father and son took the hourlong trip to Mexicali, Mexico, to Dr. Alfredo Acosta’s office.
The Fierros don’t consider themselves “health tourists.” Jesús Sr. crosses the border into Mexicali every day for his work, and Mexicali is Claudia’s hometown. They’ve been traveling to the neighborhood known as La Chinesca (“Chinatown”) for years to see Acosta, a general practitioner, who treats the asthma of their youngest son, Fernando, 15. Treatment for Jesús Jr.’s dislocated shoulder was the first time they had sought emergency care from the physician. The treatment was cost-effective and the price was right.
A visit to a U.S. emergency room likely would have involved a facility fee, expensive X-rays, and perhaps an orthopedic specialist’s evaluation — which would have generated thousands of dollars in bills. Acosta adjusted Jesús Jr.’s shoulder so that the bones aligned in the socket and prescribed him ibuprofen for soreness. The family paid cash immediately.
Although the Centers for Disease Control and Prevention doesn’t endorse traveling to another country for medical careThe Fierros are a popular choice. millions of AmericansEach year, many do. Many of them are fleeing the U.S. for better healthcare, even if they have health insurance.
Acosta is originally from Sinaloa in Mexico and graduated from the Autonomous University of Sinaloa. Acosta moved to Mexicali 20-years ago. He witnessed firsthand how the medical tourism industry has grown.
He sees between 14 and 40 patients per day, with no appointment. 30% to 40% of his patients are from the U.S. He charges $8 for most visits.
Mexicali is a mile away from La Chinesca. Here, the family doctors have modest offices. There are also medical facilities that rival those in America. Although the facilities are certified internationally, they are still less expensive than hospitals in the U.S.
Resolution: Both 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 written permission for them to do so.
In a statement, Yuma Regional Medical Center spokesperson Machele Headington said, “Applying for financial support starts with an application — a service we extended, and still extend, to these patients.”
In an email, Kraft, the Blue Cross Blue Shield of Texas spokesperson, said: “We understand the frustration our members experience when they receive a bill containing COVID-19 charges that they do not understand, or feel may be inappropriate.”
The Fierros intend to apply for financial assistance from the hospital for their outstanding debts. Claudia said that Claudia would never say it again. “I told Jesús, ‘If I faint again, please drive me home,’” rather than calling an ambulance, she said.
“We pay $1,000 premium monthly for our employment-based insurance,” added Jesús. “We should not have to live with this stress.”
The takeaway: Be aware that your deductible “meter” starts over every year and that virtually any emergency care can generate a bill in the thousands of dollars and may leave you owing most of your deductible and out-of-pocket maximum.
Also be aware that even if you seem not to qualify for financial assistance based on a hospital’s policy, you can apply and explain your circumstances. Due to the high cost for healthcare in the U.S., many people with middle income qualify. Many hospitals allow their financial departments to adjust the bills. Some patients find that if they are willing to pay cash right away, the bill can be drastically reduced.
All nonprofit hospitals have a legal obligation to help patients: They pay no tax in exchange for providing “community benefit.” Make a case for yourself, and ask for a supervisor if you get an initial “no.”
For elective procedures, patients can follow the Fierros’ example, becoming savvy health care shoppers. Claudia needed an endoscopy recently to assess an ulcer. After calling several facilities, the family discovered that there was a $500 difference in cost for an endoscopy. The family will soon travel to Central Valley, California for the procedure. It is only two hours away from their home.
The Fierros didn’t even consider going back to their local hospital. “I don’t want to say ‘hello’ and receive a $3,000 bill,” joked Jesús Sr.
Stephanie O’Neill contributed the audio portrait with this story.
Bill of the Month is a crowdsourced investigation. KHNAnd NPRThis video explains and dissects medical billing. Have a fascinating medical bill that you would like to share with us Tell us about it!
KHN (Kaiser Health News)National newsroom that produces detailed journalism on health issues. Together with Policy Analysis and Polling KHNOne of the three main operating programs at KFF(Kaiser Family Foundation). KFF is an endowed non-profit organization that provides information to the nation on health issues.
SubscribeTo KHN’sMorning Briefing free of charge
