by Agustin Durán. To read the original Spanish-language article in La Opinión, click here. (Para leer este artículo en español, haga clic aquí.)

Martha Ugarte reviews her medical bills. (Photo courtesy of Martha Ugarte)

For several decades, activist Martha Ugarte has been counseling immigrants to protect themselves from abuse and defending them from becoming victims of authorities and unscrupulous businesses. But in January 2019, the immigrant from Oaxaca, Mexico, had to defend herself.

Suddenly, her husband began to have stomach pains, and they had no choice but to take him to a hospital emergency room. After paying a $240 co-payment and enduring four hours of exams, they were told he needed surgery to remove stones from his gallbladder. They sought a second opinion and he finally managed to pass the stones with homeopathic medicine without surgery.

Ugarte’s family was aware of the high costs of health insurance in the United States and were afraid that surgery would leave them with stratospheric debt, mainly because they were already approaching their sixties and wanted to reach retirement without having to refinance their home because of health issues.

Her fears had their reason for being, as an activist Ugarte had learned of many cases where the community ended up paying extremely high figures for health care. Even a neighbor who had an epilepsy attack had stopped talking to her because of she and other people at the time called 911. What the activist did not know is that her neighbor was being charged $13,000 for that visit to the emergency room; months later he passed away.

For the Ugartes, their determination not to get sick was such that years before they had decided to lead a relatively healthy lifestyle, eating well as possible without drinking alcohol or smoking to avoid getting sick and wait to get to retirement without the need to use a medical service. However, and to their surprise, two months after stepping into the emergency room, they received a bill from the hospital for $11,000.

“He didn’t get well there. We simply stayed for four hours and left, “said Ugarte. “They wanted to perform surgery on him, but we decided not to return to the hospital. He got better by simply drinking natural juices.”

On receiving the hospital bill, Ugarte immediately went to ask why they were charging her husband so much money, if he didn’t get the surgery and didn’t get well there either. What the activist was not aware of was that in the policy she had signed with Kaiser Permanente, she had a deductible of more than seven thousand dollars per person, but since they were covered as a couple, the healthcare company was charging them with family coverage, even though only he was treated. After several visits to the billing department, she told them that she was going to sue them. They finally reduced her bill to $1,600, but not before, removing her from the healthcare program.

Now the Ugartes prefer to go to Tijuana to receive medical treatment and buy their medication, while they continue to make payments so the hospital does not take them to collections.

María Aranda, associate professor of gerontology at USC, said that unfortunately people who are not poor enough, but who do not make enough money either, are the group that finds fewer options for healthcare until they reach retirement age and can make use of the Medicare program.

That is why, many decide to go to Tijuana for medical treatment, take home remedies, and delay visits to the doctor hoping that the pain will go away on its own, but it only gets worse.

Aranda explained that there are health programs sponsored by the government through non-profit organizations or through the county in community health centers that offer services at very low prices or at no cost. But if someone has an emergency, the ambulance will surely take him or her to the nearest hospital and things may be different there.

According to a 2019 study by the American Cancer Society in the Journal of General Internal Medicine, 137.1 million Americans have faced financial hardship during the past year because of medical costs; situation that was more common among people from 18 to 64 years old.

Health Insurance Options

Yadira López, a certified agent of Covered California, the State’s Affordable Care Act program, indicated that people generally look for the cheapest options. Unfortunately, when it comes to an emergency, the coverage is as if they did not have health insurance.

An example is the plan called Bronze that only covers 60% of medical expenses and three annual doctor visits with a co-payment of $65. But the plan carries a deductible of $6,300 per person or $12,600 in a family package (prices vary according to the company).

The problem with this type of coverage is that if a doctor simply sends the patient for an X-ray, the cost will no longer cover them until pay the deductible, which makes it expensive. Also troubling is that some companies send patients to collection, as soon as it is evident that they need more time to pay. These agencies, in many cases, quickly try to place a lien on their house.

For people on covered California who own a home, López recommended signing up for the Silver program, which covers 70% of expenses with a deductible of $4,000 for a single person, or $8,000 for more than one person. With this plan you only pay a $40 copay and it covers emergency room, X-rays, laboratories, specialists etc.

Other plans with no deductible are Gold and Platinum, although they are more expensive. All rates are determined based on a  people’s age, where they live, and their income.

Negotiating and not refusing to pay

Néstor Enrique Valencia, a specialist in health care contracts and administration, said the key to avoiding large charges is to choose the most suitable health insurance according to your needs. Even if, after an emergency you end up with a very high medical bill, he recommended not to ignore the charges and to negotiate, speak the truth and pay what you can according to your possibilities, but not to refuse to pay.

Valencia stressed that people in the middle class, but who do not earn enough for more comprehensive health insurance, are most vulnerable to health charges when an emergency arises and they have to be hospitalized.

He stressed that unfortunately, medical procedures and medications are very expensive and hospitals, particularly private ones, simply limit themselves to charging for their work. If they do not receive payment, they immediately sell the account to collection agencies and at that point, there is not a lot people can do.

With little knowledge of what to do, but a lot of drive, Ugarte managed to reduce the collection of $11,000 to $1,600, by fighting with the company, as soon as she received the stratospheric charges. We contacts Kaiser Permanente to discuss the case, but they have not responded.
Agustin Durán, Metro Editor of La Opinión in Los Angeles, wrote this article in Spanish and also translated it into English with the support of a journalism fellowship from The Gerontological Society of America, Journalists Network on Generations and the Silver Century Foundation.

The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.