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April 28, 2022

How 'a string of bad medical luck' drove one family to seek health care south of the border

Daily Briefing

    After "a string of bad medical luck," which resulted in charges totaling more than $7,000 for two ED bills, one Texas family opted to seek cheaper emergency medical care in Mexico, Paula Andalo writes for Kaiser Health News.

    Infographic: The patient financial journey

    'A string of bad medical luck'

    In December 2020, Jesús Fierro Sr. was admitted to the ED at Yuma Regional Medical Center—an in-network provider under the family's health plan. After spending 18 days in the ED with a severe case of Covid-19 and losing 60 pounds, Jesús Sr. returned home "weak and dependent on an oxygen tank," Andalo writes.

    After his hospital stay, Jesús Sr. received a $3,894.86 bill for his Covid-19 treatment. The total cost of his treatment was $107,905.80.

    On Jan. 1, 2021, the Fierros' deductible and out-of-pocket maximum reset.

    Then, in June 2021, his wife, Claudia Fierro was sent to the same ED after she fainted while waiting for a table at a restaurant. According to Andalo, Claudia "felt dizzy one minute and was in an ambulance on her way to the same medical center the next." Ultimately, she was told she had low magnesium levels and was sent home in less than 24 hours.

    Soon after, Claudia received a $3,252.74 bill, which included $202.36 for treatment from an out-of-network physician. In total, the cost of her 24-hour ED visit was $13,429.50.

    'Functionally uninsured'

    While the family has health insurance through Jesús Sr.'s employer, a Houston-based oil company called NOV, they are what some experts call "functionally uninsured." 

    The Fierros' insurance plan is expensive, with an annual $8,500 out-of-pocket maximum for the entire family, and they do not have access to enough liquid savings to pay their portion of medical bills. "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 the family's disposable savings, year after year," Andalo writes.

    Each month, the Fierros pay $140 toward their medical bills—but they still owe over $2,500.

    And the Fierros are not alone. A survey from Bankrate found that less than half of U.S. adults have enough savings to cover an unexpected $1,000 expense. In addition, recent polling by the Kaiser Family Foundation found that "unexpected medical bills" were the second-highest rated family budget worry, behind gas prices and transportation costs.

    Unfortunately, the bill for Claudia's fainting spell "destabilized the Fierros' household budget," Andalo writes.

    "We thought about taking a second loan on our house," said Jesús Sr. When he called the hospital to request financial assistance, he said, the people he spoke 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.

    Seeking care south of the border

    When their son, Jesús Jr., dislocated his shoulder, Jesús Sr. asked his son, "Can you bear the pain for an hour?" To which the teenager replied, "Yes."

    Then, they made the hourlong trip to Mexicali, Mexico, to visit Alfredo Acosta's physician office—an out-of-network provider under their health plan. The Fierros had visited Acosta before to treat the asthma of their youngest son, but this was this first time they had visited the physician for emergency care.

    While an ED visit in the United States likely would have cost thousands of dollars with a facility fee, X-rays, and possibly a specialist's evaluation, Acosta adjusted Jesús Jr.'s shoulder, prescribed him ibuprofen for the pain, and billed the family about $5 for his services. "The family paid cash on the spot," Andalo writes.

    Although CDC does not recommend traveling to other countries for medical care, the Fierros are among millions of Americans who do so annually. According to Andalo, "[m]any of them are fleeing expensive care in the U.S., even with health insurance."

    Currently, the Fierros are planning to ask Yuma Regional for financial support for their remaining debts. But Claudia said never again: "I told Jesús, 'If I faint again, please drive me home,'" instead of calling an ambulance.

    "We pay $1,000 premium monthly for our employment-based insurance," added Jesús Sr. "We should not have to live with this stress." (Andalo, NPR/Kaiser Health News, 4/27)

    Resources to help support the patient financial experience

    Given the widening gap in our country between the haves and have-nots, few Americans can cover their medical costs, especially those that are unexpected. In fact, less than 40% of Americans say they could pay for a $1000 emergency expense. Rising health care costs and increasing out-of-pocket obligations have made sticker shock an inevitable experience for too many patients in health care today.

    For health care providers who want to improve the financial experience for their patients, we've curated a list of our resources to help guide your efforts:

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