Hit with $7,146 for two hospital bills, a family sought health care in Mexico

Hit with $7,146 for two hospital bills, a family sought health care in Mexico

Transcript¹

Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.

Lisa Hornak for Kaiser Health News

The Fierro family of Yuma, Ariz., had a string of bad medical luck that started in December 2020.

That's when 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, fainted while waiting for a table at the local Olive Garden restaurant. She felt dizzy one minute and was in an ambulance on her way to the same medical center the next. She was told her magnesium² levels were low and was sent home within 24 hours.

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 — opted³ out of U.S. health care and headed south to the U.S.-Mexico border.

And no other bills came for at least one member of the family.

The patients: Jesús 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, formerly⁴ National Oilwell Varco, an American multinational⁵ oil company based in Houston.

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

Total bills: Jesús 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 from an out-of-network physician. 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 in cash.

Service providers: Yuma Regional Medical Center, a 406-bed nonprofit hospital in Yuma, Ariz. 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 in which more and more Americans find themselves. They are what some experts term "functionally⁶ uninsured." They have insurance — in this case, through Jesús Sr.'s job, which pays $72,000 a year. But their health plan is expensive, and they don't have the liquid savings⁷ 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 minor⁸ encounters with the medical system can take virtually all the family's disposable savings, year after year. And that's why the Fierros opted out of U.S. health care for their son.

According to the terms of the insurance plan, which has 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 in late 2020.

The Fierros are paying off that bill — $140 a month — and still owe more than $2,500. In 2020, most insurers agreed to waive⁹ cost-sharing payments for COVID-19 treatment after the passage of federal coronavirus relief packages that provided emergency funding to hospitals. But waiving¹⁰ treatment costs was optional under the law. And although Blue Cross and Blue Shield of Texas has a 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 bill was not waived¹².

(More than two years into the coronavirus pandemic and with vaccines¹³ now widely available to reduce the risk of hospitalization and death, most insurers again charge patients their cost-sharing portion.)

On Jan. 1, 2021, the Fierros' deductible and out-of-pocket maximum reset¹⁴. 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. That kind of bill is a huge stress on many American families; fewer than half of U.S. adults have enough savings to cover a surprise $1,000 expense. In recent polling by the Kaiser Family Foundation, "unexpected medical bills" ranked second among family budget worries, behind gas prices and other transportation costs.

The new bill for the 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 to ask for financial assistance, he said, people he spoke¹¹ with strongly discouraged him from applying. "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 when 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 practitioner¹⁵, who treats the asthma¹⁶ 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 price was right, and the treatment effective.

A visit to a U.S. emergency room likely would have involved a facility fee, expensive X-rays and perhaps a specialist's evaluation¹⁷ — which would have generated thousands of dollars in bills. Acosta adjusted Jesús Jr.'s shoulder so that the bones aligned¹⁸ in the socket¹⁹ and prescribed him ibuprofen for soreness. The family paid cash on the spot.

Although the Centers for Disease Control and Prevention doesn't endorse²⁰ traveling to another country for medical care, the Fierros are among millions of Americans each year who do. Many of them are fleeing expensive care in the U.S., even with health insurance.

Acosta, who is from the Mexican state of Sinaloa and is a graduate of the Autonomous²¹ 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. He charges $8 for typical visits.

In Mexicali, a mile from La Chinesca, where the 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: Both 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 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 and Blue Shield of Texas spokesperson, said: "We understand the frustration²² our members experience when they receive a bill containing COVID-19 charges that they do not understand, or feel may be inappropriate."

The Fierros are planning to apply to the hospital for financial support for their outstanding debts. But Claudia said never again: "I told Jesús, 'If I faint again, please drive me home,' " rather than call an ambulance.

"We pay $1,000 premium²³ 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 your deductible and most of your 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. Because of the high cost of care in the U.S., even many middle-income people qualify. And many hospitals give their finance departments leeway to adjust bills. Some patients discover that if they offer to pay cash on the spot, the bill can be reduced dramatically.

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 supervisor²⁴ if you get an initial no.

For elective procedures, patients can follow the Fierros' example, becoming savvy²⁵ health care shoppers. Recently, Claudia needed an endoscopy to evaluate an ulcer²⁶. 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, 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 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 investigation²⁷ by KHN and NPR that dissects²⁸ and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

1 transcript   

n.抄本，誊本，副本，肄业证书

参考例句：

• A transcript of the tapes was presented as evidence in court.一份录音带的文字本作为证据被呈交法庭。
• They wouldn't let me have a transcript of the interview.他们拒绝给我一份采访的文字整理稿。

2 magnesium   

n.镁

参考例句：

• Magnesium is the nutrient element in plant growth.镁是植物生长的营养要素。
• The water contains high amounts of magnesium.这水含有大量的镁。

3 opted   

v.选择，挑选( opt的过去式和过去分词 )

参考例句：

• She was co-opted onto the board. 她获增选为董事会成员。
• After graduating she opted for a career in music. 毕业后她选择了从事音乐工作。

4 formerly   

adv.从前，以前

参考例句：

• We now enjoy these comforts of which formerly we had only heard.我们现在享受到了过去只是听说过的那些舒适条件。
• This boat was formerly used on the rivers of China.这船从前航行在中国内河里。

5 multinational   

adj.多国的，多种国籍的；n.多国籍公司，跨国公司

参考例句：

• The firm was taken over by a multinational consulting firm.这家公司被一个跨国咨询公司收购。
• He analyzed the relationship between multinational corporations and under-developed countries.他分析了跨国公司和不发达国家之间的关系。

6 functionally   

adv.机能上地，官能地

参考例句：

• Objective To explore occlusion reconstruction by computer aided design (CAD) with functionally-generated pathway (FGP). 目的探索借助功能性？记录(functionally-generated pathway,FGP)技术进行口腔固定修复体计算机辅助设计(Computer aided Design,CAD)生理性建？的方法。 来自互联网
• In this respect, the proceeding was functionally similar to a comparative licensing adjudication. 在这一点上，手续在作用上即类似于比较许可证发放的裁断。 来自英汉非文学 - 行政法

7 savings   

n.存款，储蓄

参考例句：

• I can't afford the vacation,for it would eat up my savings.我度不起假，那样会把我的积蓄用光的。
• By this time he had used up all his savings.到这时，他的存款已全部用完。

8 minor   

adj.较小(少)的，较次要的；n.辅修学科；vi.辅修

参考例句：

• The young actor was given a minor part in the new play.年轻的男演员在这出新戏里被分派担任一个小角色。
• I gave him a minor share of my wealth.我把小部分财产给了他。

9 waive   

vt.放弃，不坚持(规定、要求、权力等)

参考例句：

• I'll record to our habitat office waive our claim immediately.我立即写信给咱们的总公司提出放弃索赔。
• In view of the unusual circumstances,they agree to waive their requirement.鉴于特殊情况，他们同意放弃他们的要求。

10 waiving   

v.宣布放弃( waive的现在分词 )；搁置；推迟；放弃（权利、要求等）

参考例句：

• Other steps suggested included waiving late payment charges, making quicker loan decisions and easing loan terms. 其他测试还包括免去滞纳金，尽快做出贷款决定和放宽贷款条件。 来自互联网
• Stuyvesant Town offers the same perk on some apartments, along waiving the broker's fee. StuyvesantTown对于他们出租的某些房子也提供同样的好处，顺带还省略了中介费。 来自互联网

11 spoke   

n.（车轮的）辐条；轮辐；破坏某人的计划；阻挠某人的行动 v.讲，谈（speak的过去式）；说；演说；从某种观点来说

参考例句：

• They sourced the spoke nuts from our company.他们的轮辐螺帽是从我们公司获得的。
• The spokes of a wheel are the bars that connect the outer ring to the centre.辐条是轮子上连接外圈与中心的条棒。

12 waived   

v.宣布放弃( waive的过去式和过去分词 )；搁置；推迟；放弃（权利、要求等）

参考例句：

• He has waived all claim to the money. 他放弃了索取这笔钱的权利。 来自《简明英汉词典》
• I waived the discourse, and began to talk of my business. 我撇开了这个话题，开始讲我的事情。 来自辞典例句

13 vaccines   

疫苗，痘苗( vaccine的名词复数 )

参考例句：

• His team are at the forefront of scientific research into vaccines. 他的小组处于疫苗科研的最前沿。
• The vaccines were kept cool in refrigerators. 疫苗放在冰箱中冷藏。

14 reset   

v.重新安排，复位；n.重新放置；重放之物

参考例句：

• As soon as you arrive at your destination,step out of the aircraft and reset your wristwatch.你一到达目的地，就走出飞机并重新设置手表时间。
• He is recovering from an operation to reset his arm.他做了一个手臂复位手术，正在恢复。

15 practitioner   

n.实践者，从事者；(医生或律师等)开业者

参考例句：

• He is an unqualified practitioner of law.他是个无资格的律师。
• She was a medical practitioner before she entered politics.从政前她是个开业医生。

16 asthma   

n.气喘病，哮喘病

参考例句：

• I think he's having an asthma attack.我想他现在是哮喘病发作了。
• Its presence in allergic asthma is well known.它在过敏性气喘中的存在是大家很熟悉的。

17 evaluation   

n.估价，评价；赋值

参考例句：

• I attempted an honest evaluation of my own life.我试图如实地评价我自己的一生。
• The new scheme is still under evaluation.新方案还在评估阶段。

18 aligned   

adj.对齐的，均衡的

参考例句：

• Make sure the shelf is aligned with the top of the cupboard.务必使搁架与橱柜顶端对齐。

19 socket   

n.窝，穴，孔，插座，插口

参考例句：

• He put the electric plug into the socket.他把电插头插入插座。
• The battery charger plugs into any mains socket.这个电池充电器可以插入任何类型的电源插座。

20 endorse   

vt.(支票、汇票等)背书，背署；批注；同意

参考例句：

• No one is foolish enough to endorse it.没有哪个人会傻得赞成它。
• I fully endorse your opinions on this subject.我完全拥护你对此课题的主张。

21 autonomous   

adj.自治的；独立的

参考例句：

• They proudly declared themselves part of a new autonomous province.他们自豪地宣布成为新自治省的一部分。
• This is a matter that comes within the jurisdiction of the autonomous region.这件事是属于自治区权限以内的事务。

22 frustration   

n.挫折，失败，失效，落空

参考例句：

• He had to fight back tears of frustration.他不得不强忍住失意的泪水。
• He beat his hands on the steering wheel in frustration.他沮丧地用手打了几下方向盘。

23 premium   

n.加付款；赠品；adj.高级的；售价高的

参考例句：

• You have to pay a premium for express delivery.寄快递你得付额外费用。
• Fresh water was at a premium after the reservoir was contaminated.在水库被污染之后，清水便因稀而贵了。

24 supervisor   

n.监督人，管理人，检查员，督学，主管，导师

参考例句：

• Between you and me I think that new supervisor is a twit.我们私下说，我认为新来的主管人是一个傻瓜。
• He said I was too flighty to be a good supervisor.他说我太轻浮不能成为一名好的管理员。

25 savvy   

v.知道，了解；n.理解能力，机智，悟性；adj.有见识的，懂实际知识的，通情达理的

参考例句：

• She was a pretty savvy woman.她是个见过世面的漂亮女人。
• Where's your savvy?你的常识到哪里去了？

26 ulcer   

n.溃疡，腐坏物

参考例句：

• She had an ulcer in her mouth.她口腔出现溃疡。
• A bacterium is identified as the cause for his duodenal ulcer.一种细菌被断定为造成他十二指肠溃疡的根源。

27 investigation   

n.调查，调查研究

参考例句：

• In an investigation,a new fact became known, which told against him.在调查中新发现了一件对他不利的事实。
• He drew the conclusion by building on his own investigation.他根据自己的调查研究作出结论。

28 dissects   

v.解剖（动物等）( dissect的第三人称单数 )；仔细分析或研究

参考例句：

• Meltzer dissects the penile skin free of the underlying erectile tissue. Meltzer将阴茎表皮与其下的勃起组织分割。 来自互联网
• This paper dissects the process to analyse arsenic in test method and operative skills. 本文从实验方法、操作技巧等方面剖析了砷测定方法的机理。 来自互联网