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. In 2020, most insurers agreed to waive cost-sharing payments for COVID-19 treatment after the passage of federal COVID relief packages that provided emergency funding to hospitals. But waiving treatment costs was optional under the law. And although Blue Cross 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 COVID bill was not waived.
(More than two years into the pandemic and with vaccines now widely available to reduce the risk of hospitalization and death, most insurers again 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. That kind of bill is a huge stress on the average American family; fewer than half of U.S. adults have enough savings to cover a 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 to ask for financial assistance, he said, 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.
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 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 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 on the spot.